Sample PCP Letter
Hi folks,
I need to get a letter from my primary care physician regarding all medical conditions/weight loss, etc. The surgeon's office said to have them something about not having cardiac problems, unsatisfactory weight loss, etc. This is in support of a revision. Are there any good letters out there that anyone has written before that they wouldn't mind if I used as a guide?
I need to get a letter from my primary care physician regarding all medical conditions/weight loss, etc. The surgeon's office said to have them something about not having cardiac problems, unsatisfactory weight loss, etc. This is in support of a revision. Are there any good letters out there that anyone has written before that they wouldn't mind if I used as a guide?
~Mandy~ 
Lap Band - Feb 28, 2007 Revised to DS Dec 1, 2009
5' 5" - HW 240, SW 200, CW 132, GW 125
Something like this one?
Request for Pre-approval for Duodenal Switch surgery
To Whom It May Concern:
Mrs. (Last Name) has been under the care of ( PA-C's name here) for the past 9 plus years. She is 37 years of age, stands 5’3" tall and weighs 226 lbs. She has a history of childhood and adult obesity with a current BMI of 40.6.
Mrs. (Last Name)’s weight condition has caused her significant health problems, some of which appear to be getting progressively worse as time goes on. Some of this patient’s current health problems aregastro esophageal reflux disease (GERD), urinary stress incontinence, leg, ankle and hip pain, depression, and edema. Family medical history is positive for obesity, hypertension, diabetes, heart disease, and hypercholesterolemia.
Mrs. (Last Name) knows the health risk associated with morbid obesity and has done her best at attempts to control her weight. In an effort to resolve her weight problem, she has undergone numerous weight loss treatment plans such as:
Mrs. (Last Name) has been under the care of this office for the past nine plus years and within that time we have monitored her success/failure on weight loss programs. She is seeking rectification from her failed RNY. Unfortunately, it is causing her great pain and has had no long-term success. She is currently planning a revision to the Duodenal Switch.
Mrs. (Last Name) has been over 200 lbs for the past 22 years, with the exception of 2 years following her 2002 RNY, and up until a few years ago has been extremely lucky not to of have any major health concerns. Mrs. (Last Name)’s attempt at losing and re-gaining weight has only proven to cause her more health concerns. Mrs. (Last Name) is a very active female. She works as a clerk in the warehouse at the telephone company, which demands many hours standing and walking. Mrs. (Last Name) is experiencing severe pain in her knees and hips as well as ankle and calf swelling and unable to take anti-inflammatory (NSAIDS) due to her current RNY pouch. I believe weight loss would help to eliminate these symptoms. Mrs. (Last Name) also has a family history of diabetes. Her obesity places her at greater risk for adult-onset obesity; as nearly 80% of patients with this disease are obese. It is time for a permanent resolution to eliminate future health concerns related to morbid obesity.
I trust this information will aide you in understanding the true severity of Mrs. (Last Name)'s case and in facilitating the proper assessment. Please feel free to contact me if I can answer or clarify any questions you might have.
Sincerely, (PCP's signature)
Request for Pre-approval for Duodenal Switch surgery
To Whom It May Concern:
Mrs. (Last Name) has been under the care of ( PA-C's name here) for the past 9 plus years. She is 37 years of age, stands 5’3" tall and weighs 226 lbs. She has a history of childhood and adult obesity with a current BMI of 40.6.
Mrs. (Last Name)’s weight condition has caused her significant health problems, some of which appear to be getting progressively worse as time goes on. Some of this patient’s current health problems aregastro esophageal reflux disease (GERD), urinary stress incontinence, leg, ankle and hip pain, depression, and edema. Family medical history is positive for obesity, hypertension, diabetes, heart disease, and hypercholesterolemia.
Mrs. (Last Name) knows the health risk associated with morbid obesity and has done her best at attempts to control her weight. In an effort to resolve her weight problem, she has undergone numerous weight loss treatment plans such as:
| Diet | Date | Duration | Start Wt. | Loss | End Wt. |
| Phentermine | 1/09 | 7 months | 235 | 9 | 226 |
| Curves | 2/08 | 3 months | 233 | 15 | 218 |
| RNY | 2/02 | 7 years | 298 | 72 | 226 |
| Phen-Fen | 6/96 | 6 months | 278 | 59 | 219 |
| Atkins | 5/98 | 4 months | 280 | 5 | 275 |
| Low Calorie | 7/84 | 25 years off & on | 175 | +51 | 226 |
| TOPS | 7/84 | 5 years off & on | 175 | +85 | 260 |
Mrs. (Last Name) has been under the care of this office for the past nine plus years and within that time we have monitored her success/failure on weight loss programs. She is seeking rectification from her failed RNY. Unfortunately, it is causing her great pain and has had no long-term success. She is currently planning a revision to the Duodenal Switch.
Mrs. (Last Name) has been over 200 lbs for the past 22 years, with the exception of 2 years following her 2002 RNY, and up until a few years ago has been extremely lucky not to of have any major health concerns. Mrs. (Last Name)’s attempt at losing and re-gaining weight has only proven to cause her more health concerns. Mrs. (Last Name) is a very active female. She works as a clerk in the warehouse at the telephone company, which demands many hours standing and walking. Mrs. (Last Name) is experiencing severe pain in her knees and hips as well as ankle and calf swelling and unable to take anti-inflammatory (NSAIDS) due to her current RNY pouch. I believe weight loss would help to eliminate these symptoms. Mrs. (Last Name) also has a family history of diabetes. Her obesity places her at greater risk for adult-onset obesity; as nearly 80% of patients with this disease are obese. It is time for a permanent resolution to eliminate future health concerns related to morbid obesity.
I trust this information will aide you in understanding the true severity of Mrs. (Last Name)'s case and in facilitating the proper assessment. Please feel free to contact me if I can answer or clarify any questions you might have.
Sincerely, (PCP's signature)
RNY 2/26/2002 DS 12/29/2011
HW 317 SW 263 BMI 45.1
SW 298 CW 192 BMI 32.9~60% EWL
LW 151 in 2003
TT 4/9/2003
Normal BMI 24.8 is my GOAL!!!
GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**
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