719 Thompson Lane Suite Nashville, TN (615) fax (615)

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Suzan Richards
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1 Vanderbilt Center for Surgical Weight Loss 719 Thompson Lane Suite Nashville, TN (615) fax (615) Dear Patient, Welcome and thank you for choosing the Vanderbilt Center for Surgical Weight Loss. We look forward to assisting you in making the most important health related decision of your life. Your Pathway to Surgery 1. Schedule a Surgical Evaluation 2. Make appointment with your Primary Care Physician to: a. obtain letter of medical necessity b. complete required lab work (please refer to lab work handout) c. begin weight loss program OR (depending on insurance requirements) d. obtain weight loss records of previous weight loss program(s) 3. Complete required Pre-Operative Consultations and Appointments (these will be discussed during your initial evaluation): a. psychological evaluation b. pre-surgical nutrition assessment c. attend one support group d. view the online seminar e. additional testing may be needed based on your medical history (examples: cardiac stress test, endoscopy, x-rays, etc.) Completion of the above does not guarantee surgery will be scheduled. We use these evaluations to determine if surgery is safe for you. 4. If you are determined to be a good surgical candidate, a predetermination letter will be sent to your insurance carrier in order to obtain insurance approval. This process may take a month. 5. We will contact you as soon as your insurance carrier notifies us of their decision. You may receive notification from your insurance provider before we do. If this is the case, call us at (615) Once insurance approval is acquired, you will be scheduled for surgery. If you have any questions, feel free to call our office at (615) We look forward to working with you. Sincerely, Vanderbilt Center for Surgical Weight Loss

Make appointment with your Primary Care Physician to: a. obtain letter of medical necessity b. complete required lab work (please refer to lab work handout) c.

2 Support Group Meetings Vanderbilt Center for Surgical Weight Loss One Hundred Oaks 719 Thompson Lane Suite Vanderbilt Tuesday Support Group Second Tuesday of every month at 5:00 p.m. Vanderbilt Health One Hundred Oaks, Suite Moderator: L.T. Kirk- patient representative Vanderbilt wednesday Support Group Every Wednesday at 1:30 p.m. Vanderbilt Health One Hundred Oaks, Suite 26102/26104 Moderator: Trina Davis patient representative Vanderbilt thursday post-op Support Group Fourth Thursday of every month at 5:30 p.m. Vanderbilt Health One Hundred Oaks, Suite Moderator: Sherise Stogner patient representative

m. Vanderbilt Health One Hundred Oaks, Suite 26102/26104 Moderator: Trina Davis patient representative Vanderbilt thursday post-op Support Group Fourth

3 lab work request Vanderbilt Center for Surgical Weight Loss One Hundred Oaks 719 Thompson Lane Suite Nashville, TN (615) Fax (615) We request your assistance with the preoperative medical management. The attached labs are routine tests the Vanderbilt Center for Surgical Weight Loss requests prior to surgery to exclude common deficiencies that can adversely affect the patient s postoperative course. Please incorporate these tests as part of your routine preoperative medical evaluation and have the patient bring the results to their initial consultation at the Vanderbilt Center for Surgical Weight Loss or fax results to (615) Please fast for 8 12 hours prior to obtaining lab work. Labs: CMP CBC Ferritin, TIBC, Serum Iron Vitamin B-12 Vitamin B-1 (Thiamine) Vitamin D (25-OH) PTH (intact) TSH Lipid Profile HgA1C

The attached labs are routine tests the Vanderbilt Center for Surgical Weight Loss requests prior to surgery to exclude common deficiencies that can adversely affect the patient s postoperative

4 Vanderbilt Center for Surgical Weight Loss 719 Thompson Lane Suite Nashville, TN (615) fax (615) Dear Physician, Your patient has expressed genuine interest in having surgical weight loss by attending an informational seminar. This surgeon-lead information seminar thoroughly discusses the entire program from operations offered to lifestyle changes required for success. We would like to work with your office to obtain insurance prior-authorization for your patient s operation. Because most insurers require it, we need a letter of medical necessity for bariatric surgery from you, the primary care physician, to send along with ours to the patient s insurance company. Patients are required to document prior weight loss attempts to ensure that surgery is only sought after diet, exercise, and medical management have failed to achieve longterm success. We have given your patient a detailed list of the requirements for their particular insurance company, which we ask that they share with you. Most companies (including Medicare) require documentation of the following: Medical history - Current diagnoses and medications - Weight history including duration of obesity Weight loss attempts in the past Some companies also require 10% weight loss or recent weight loss program supervised by the primary care provider prior to insurance approval. Documentation of this program must include: Notes from monthly clinical encounters with health professional that show: - Weights from monthly weigh-ins - Current diet and exercise program - Evidence of education and behavioral therapy by health professional - Consideration of or use of pharmacotherapy A summary letter at completion of program We also request your assistance with the preoperative medical management. The attached labs are routine tests Vanderbilt Surgical Weight Loss requests prior to surgery to exclude common deficiencies that can adversely affect the patient s postoperative course. Please incorporate these tests as part of your routine preoperative medical evaluation and have the patient bring the results to their initial consultation at the Vanderbilt Center for Surgical Weight Loss. Thank you for allowing us to participate in the care of your patient. We look forward to establishing a mutually beneficial relationship with you and your patient. Please do not hesitate to contact us at if you have any questions. Sincerely, Vanderbilt Center for Surgical Weight Loss

This surgeon-lead information seminar thoroughly discusses the entire program from operations offered to lifestyle changes required for success.

5 Weight Loss Surgery Top 10 Behaviors 1. eat only 3 small meals a day. Do not eat between meals. 8. Drink 8 cups (64 oz) of fluid per day. 2. Make all meals at least 75% high protein foods. 3. Eat slowly and chew thoroughly (25-30 times a bite). 4. Stop eating as soon as you feel a hint of fullness. 5. Do not drink while eating or near eating. 6. Do not eat sugar or sweets. 9. Drink only low-calorie or zero-calorie liquids, with the exception of high protein drinks soon after surgery. You must also avoid ice cream, frozen yogurt, and sherbets, including those that are low in fat and sugar. 10. Exercise daily. 7. Avoid high fat/high calorie foods: fried foods fatty meals (e.g. sausage, bologna) added fat for seasoning (e.g., butter, meat grease) creamy sauces, soups and dressings

Drink only low-calorie or zero-calorie liquids, with the exception of high protein drinks soon after surgery.

6 certificate of support group attendance This certificate is awarded to on for attending support group at Support Group leader date

PREOPERATIVE MANAGEMENT FOR BARIATRIC PATIENTS. Adrienne R. Gomez, MD Bariatric Physician St. Vincent Bariatric Center of Excellence

PREOPERATIVE MANAGEMENT FOR BARIATRIC PATIENTS Adrienne R. Gomez, MD Bariatric Physician St. Vincent Bariatric Center of Excellence BARIATRIC SURGERY Over 200,000 bariatric surgical procedures are performed