Pcp bariatric surgery clearance letter
[PDF File]Sinai Hospital of Baltimore Division of Bariatric Surgery ...
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Apr 19, 2013 · insurance companies of all patients prior to scheduling surgery: 1) Proof of attendance at a minimum of one of our bariatric seminars or webinars. 2) A letter from your primary care physician. This letter should summarize your diet history,your obesity- related medical problems and any physician-supervised weight loss attempts that you have had.
[PDF File]Pathway to Bariatric Surgery Checklist - Trinity Medical, WNY
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Apr 19, 2018 · Pathway to Bariatric Surgery Checklist ... - Sample letter is provided for your Primary Care Physician Step 2: Psychological Evaluation - Please verify with your insurance that the service provider is in-network Dr. Ron Lelito (716) 631-3555 400 International Dr. ...
[PDF File]12395-01 Bariatric Surgery Guidebook.indd 1 9/4/20 9:20 AM
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12395-01 Bariatric Surgery Guidebook.indd 2 9/4/20 9:20 AM. Your Booklet Includes PREPARING FOR YOUR BARIATRIC SURGERY ... q PCP clearance letter q PCP pre-op visit and labs q EKG q EGD, upper endoscopy q Mammogram (women over 40 within the last 12 …
[PDF File]Introduction
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PCP pre-op visit, labs, clearance letter After all of the steps have been completed, we will send a letter to your PCP to schedule a pre operative clearance appointment. The letter will provide exact details of what labs must be completed. If missing a mammogram or an EKG, they can be ordered by your PCP …
[PDF File]PREOP CLEARANCE LETTER - AzISKS
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PREOP CLEARANCE LETTER Please give this to the provider who will be clearing you for surgery I, MD/DO/NP/PA, have examined this patient, checked all appropriate lab work and tests and certify, that to the best of my knowledge, there is not a medical contraindication for undergoing elective surgery with a general and/or regional anesthesia.
[PDF File]Surgical Clearance Requirements
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Surgical Clearance Requirements Dear Doctor: Your patient has been scheduled for foot/ankle surgery. A medical clearance is required by all facilities to ensure a safe outcome. Please fax complete clearance to our office at 703-560-2151. History and Physical Exam and Labs are valid for 30 days. EKG’s that are normal are valid for 90 days.
[PDF File]SAMPLE LETTER OF MEDICAL NECESSITY FOR BARIATRIC …
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bariatric surgery from a cardiac and/or pulmonary standpoint. The remainder of the physical exam is unremarkable. I believe the patient is a good candidate for surgery and would benefit from significant weight loss. I would be happy to see the patient again prior to surgery for medical clearance. Sincerely, Sample McSampleton
[PDF File]Physican Letterhead OR MEDICAL NECESSITY
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I am respectfully requesting pre-authorization for Bariatric surgery to include patient’s benefits and coverage. Thank you for your kind consideration in this matter. Sincerely, [Physician Name] SAMPLE LETTER OF MEDICAL NECESSITY: (Give this to your Primary Care Physician to complete and send to our office or give to You). This
[PDF File]Bariatric Booklet - Kaiser Permanente
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Entering the Bariatric Surgery Program Medical research has shown that Bariatric Surgery is a safe and effective way to lose weight and improve health for a specific group of patients. Our Bariatric Surgery Program is structured to help those people reach their health goals. To help you get started and to know what to expect, the steps of the
[PDF File]Letter from the primary care physician supporting patient ...
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6. Letter from the primary care physician supporting patient’s pursuit of weight loss surgery to help control medical co-morbidities 7. Cardiologist – for use of weight loss medication or cardiac clearance for surgery 8. Pulmonologist- for asthma, COPD, etc or clearance for surgery 9. Sleep Study Consult- …
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