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Date: REFERRAL: BARIATRIC SURGERY Patient Name: DOB: Dear Dr. Keith Buccal and Dr. Craig Flock, I am recommending my patient undergo bariatric surgery. Per my request, please evaluate my patient,
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How to fill out referral bariatric surgery
How to fill out referral bariatric surgery
01
To fill out a referral for bariatric surgery, follow these steps:
02
Obtain the necessary referral form from your healthcare provider.
03
Fill out your personal information, including your name, address, and contact details.
04
Provide your medical history, including any previous surgeries or medical conditions.
05
Include information about your weight, height, and body mass index (BMI).
06
Specify the reason for seeking bariatric surgery and any related complications.
07
Attach any supporting documents, such as medical records or test results.
08
Review the form for accuracy and completeness before submitting it.
09
Submit the completed referral form to your healthcare provider or the designated bariatric surgery center.
10
Follow up with your healthcare provider to ensure that your referral has been processed.
Who needs referral bariatric surgery?
01
Bariatric surgery may be recommended for individuals who meet certain criteria, including:
02
- Being severely obese with a body mass index (BMI) of 40 or higher.
03
- Having a BMI of 35 or higher with obesity-related medical conditions, such as diabetes, hypertension, or sleep apnea.
04
- Previous unsuccessful attempts at weight loss through diet, exercise, or medication.
05
- Being committed to making long-term lifestyle changes and participating in post-surgery care and support.
06
- Undergoing a comprehensive evaluation to assess physical and psychological readiness for the surgery.
07
It is important to consult with a healthcare provider or a bariatric surgeon to determine if referral bariatric surgery is appropriate for your individual situation.
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What is referral bariatric surgery?
Referral bariatric surgery is a process where a healthcare provider refers a patient to a specialist for weight loss surgery.
Who is required to file referral bariatric surgery?
Healthcare providers such as primary care physicians or specialists are required to file referral bariatric surgery.
How to fill out referral bariatric surgery?
To fill out referral bariatric surgery, healthcare providers need to complete a referral form with necessary patient information and medical history.
What is the purpose of referral bariatric surgery?
The purpose of referral bariatric surgery is to help patients who are struggling with obesity to achieve significant weight loss and improve their overall health.
What information must be reported on referral bariatric surgery?
Information such as patient's name, contact information, medical history, and reason for referral must be reported on referral bariatric surgery.
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