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PLEASE FORWARD REFERRALS TO CHI COMPLEX OBESITY SERVICE, CHI TEMPLE STREET, DUBLIN 1, D01 YC67NEW CHI COMPLEX OBESITY SERVICE REFERRAL FORM CHILDREN 2 16 yrs old with BMI +4 SD OR 99.6th PERCENTILE

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How to fill out weight management service referrals

01

Obtain the referral form from the weight management service provider.

02

Fill out the client's personal information such as name, contact information, and demographic details.

03

Provide details about the client's medical history, current medications, and any underlying health conditions.

04

Include information about the client's weight management goals and reasons for seeking the service.

05

Sign and date the referral form before submitting it to the weight management service provider.

Who needs weight management service referrals?

01

Individuals who are struggling with weight issues and want professional assistance in managing their weight effectively.

02

Healthcare providers who have identified patients in need of weight management services and want to refer them to a specialized provider.

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What is weight management service referrals?

Weight management service referrals are recommendations made by healthcare providers to individuals who are seeking assistance with managing their weight.

Who is required to file weight management service referrals?

Healthcare providers and facilities are required to file weight management service referrals.

How to fill out weight management service referrals?

Weight management service referrals can be filled out by providing the patient's information, medical history, weight management goals, and recommended treatment plan.

What is the purpose of weight management service referrals?

The purpose of weight management service referrals is to help individuals receive professional guidance and support in their weight management journey.

What information must be reported on weight management service referrals?

Weight management service referrals must include the patient's demographic information, medical history, weight management goals, and recommended treatment plan.

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