Impromy Weight Loss 2014

Transcription

1 Impromy Weight Loss 2014 Impromy Member Number: Client Details Name: Address: Mobile #: Initial Consultation Age Range: Gender: Welcome to the Impromy Program Introduce yourself (mention that you are a trained Impromy consultant). "Welcome to the Impromy Program, developed in collaboration with CSIRO." If you re not sure what to say, try some of these points: Impromy is already one of Australia s most successful weight loss and health programs. Impromy is based on healthy eating and has been clinically tested to ensure success. Impromy combines pharmacy advice, health measures, meal replacement products, phone and online support and a Smartphone App to help you lose weight. Ask the customer how much they already know about Impromy. If they haven t heard much about it, you can describe it: Over 1,000,000 (1 million) Australians have purchased CSIRO s previous recipe books and tried their weight loss programs. The program has been tested and proven by CSIRO s research. The program will drive ongoing research and development into weight loss and health. Rapid weight loss occurs early in the program. Men can expect to lose up to 2.5kg per week in the beginning. Women can expect to lose up to 2kg per week in the beginning. The program is tailored and individualised to you. Lots of support is available, through this store, on the phone and online. Your membership pack contains a CSIRO Recipe Book, the Impromy Guide to Getting Started and your membership card. You ll also receive ongoing support for free and a code to download our Smartphone App.

2 Eligibility Criteria Some of the criteria on this list will require your doctor s approval to us for you to proceed on the program please see your health professional to discuss this further and if possible to seek their clearance to proceed. Eligibility Criteria Questions Do you have a referral from a GP or health professional? Are you less than 16 years of age? Are you pregnant or breastfeeding? Are you diabetic (type 1 or type 2)? Do you use a medication other than Metformin (Diabex)? Do you take Lithium, Mono-amine Oxidase Inhibitors or Anticoagulants (e.g. Warfarin)? Do you have any other condition, explained on the extended criteria form? Yes/No Patient agrees to the terms & conditions of the Impromy Program? Weight & Health Measures Base Profile Questions Yes/No Quantity Do you smoke? Do you exercise? Do you drink alcohol? Cigarettes per day Hours per week Drinks per day Health Measures We are now going to measure some indicators of your health, including Blood Pressure, Cholesterol and Blood Sugars. You will receive a report with this information, for your own records. It involves a pin-prick blood test. This is an important part of the program, but if you are not comfortable you can opt-out of this testing. Patient Agrees to Point of Care Testing? Point of Care Questions Referral Required Measurement Systolic (mmhg) > 180 mmhg Diastolic (mmhg) > 110 mmhg Total Cholesterol (mmol/l) > 6.5mmol/l Blood Glucose Level (mmol/l) > 11 mmol/l

3 Additional Referral Notes Default Eating Plan Gender Phase Default Level Eating Plan Female Motivate A 2 Meal replacements 1 Higher protein meal 2 program Snack Male Motivate B 3 Meal replacements 1 Higher protein meal 2 program Snack * To be used as initial default only when GUILDCARE is not accessible. NB Advance and Sustain will require GUILDCARE guidance, default if GUILDCARE not accessible on these occasions is to maintain current program status. ** Default predictions based on previous clinical trial experience (Refer to CSIRO). Results Recommended Starting Phase and Level Balanced Meals Each Day Light Meals Each Day Snacks Each Day Shakes Each Day Estimated Daily Energy Expenditure kj

4 Impromy Weight Loss 2014 Impromy Member Number: Client Details Name: Address: Mobile #: Follow Up Visit Visit Type (Top-Up, Regular, Milestone) Age Range: Gender: Date of Visit If this is a 4-week, 3 month, 6-month or 12-month milestone visit, the client is entitled to have their health measures taken for free. BMI Calculation Weight (kg) Height (cm) Change (kg) Calculated BMI (kg/m 2 ) Measurement Health Measures Testing is an option part of a non-milestone visit and can be included and charged at the discretion of the pharmacy staff. Patient Agrees to Point of Care Testing? Point of Care Questions Referral Required Measurement Systolic (mmhg) > 180 mmhg Diastolic (mmhg) > 110 mmhg Total Cholesterol (mmol/l) > 6.5mmol/l Blood Glucose Level (mmol/l) > 11 mmol/l Compliance Ask the client how they are going on the program and whether they have had any issues. Discuss their weight change since their last visit and whether they are happy with their current results. Is client happy with the results so far and keen to continue at their current program phase & level? Is the client complying with the program OK so far?

5 Determine whether the client would like to move to another phase on the program, utilising fewer meal replacements each day but potentially reducing the rate of weight loss. The ADVANCE Phase contains one less meal replacement each day and introduces a Light Meal. The SUSTAIN Phase is a healthy eating plan including Program Snacks. Action (Select only 1) Stay on Current Phase Move to Motivate Move to Advance Move to Sustain Please add any extra comments about this client in the box below. Recommendations Next Visit Date