Get the free Patient History Form: Bariatric Surgery Page 1 of 9 - ThedaCare - thedacare

Date you attended Informational Session / / How did you hear about us? Radio Newspaper TV Word of Mouth Magazine Referred by Dr. Other: Name: Age: Date of Birth: / / Occupation: Gender: Male/Female

How to fill out patient history form bariatric

How to fill out a patient history form for bariatric patients:

1. Start by providing your personal information, including your name, date of birth, address, and contact details. It is essential to ensure that the information is accurate and up-to-date.
2. Next, answer questions related to your medical history. This includes any previous surgeries, chronic conditions, allergies, and medications you are currently taking. Be thorough in providing details and include any relevant information that might affect your bariatric surgery.
3. Fill in details about your lifestyle and habits. This includes questions about your dietary habits, exercise routine, and any substance use like smoking or alcohol consumption. These details help the medical team better understand your lifestyle choices and their impact on your overall health.
4. Answer questions about your psychological and emotional well-being. Bariatric surgery requires psychological evaluations to ensure that patients are mentally prepared for the procedure and the lifestyle changes that follow. Be honest in providing information about your mental health history, including any previous diagnoses or treatment.
5. List any previous weight loss attempts and their outcomes, including diets, exercise programs, and medications used. It is crucial to provide an accurate account to help your healthcare team understand your previous experiences and tailor your bariatric treatment accordingly.
6. Finally, sign and date the form to acknowledge that the information provided is accurate to the best of your knowledge. If there are any areas of uncertainty or questions, do not hesitate to seek clarification from your healthcare provider.

Who needs a patient history form for bariatric surgery?

1. Individuals who are considering or have been recommended for bariatric surgery need to fill out a patient history form. This includes those struggling with severe obesity and related health issues that have not responded well to other weight loss methods.
2. Patients who are committed to making significant lifestyle changes before and after bariatric surgery should also complete this form. Bariatric surgery requires a long-term commitment to dietary changes, exercise, and ongoing medical care, so it is essential to assess a patient's readiness and ability to comply.
3. Healthcare professionals, including doctors, surgeons, and nurses, also use patient history forms for bariatric surgery. It helps them gather necessary information to understand the patient's medical and psychological history, ensuring safe and effective treatment planning.

Overall, the patient history form for bariatric surgery is crucial for both patients and healthcare professionals to ensure a comprehensive assessment of the patient's health and readiness for the procedure.

For pdfFiller’s FAQs

What is patient history form bariatric?

The patient history form bariatric is a document that gathers information about a patient's medical history, specifically related to bariatric surgery.

Who is required to file patient history form bariatric?

Patients who are considering or have undergone bariatric surgery are required to fill out the patient history form bariatric.

How to fill out patient history form bariatric?

The patient can fill out the form either electronically or by hand, providing accurate information about their medical history, previous surgeries, and current conditions.

What is the purpose of patient history form bariatric?

The purpose of the patient history form bariatric is to help healthcare providers assess the patient's suitability for bariatric surgery, identify potential risks, and plan appropriate care.

What information must be reported on patient history form bariatric?

The patient must report their medical history, previous surgeries, current medications, allergies, lifestyle habits, and any comorbidities on the patient history form bariatric.

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