Bariatric Registry Form

Would anyone have the bariatric form that your family Dr fills out and sends in?

I would be interested in seeing what they ask etc.

Many thanks!!

Its electronic, and something your doctor has to register on the site to obtain... My doctor went through it with me point by point. It pretty much asked if you have any comorbidities, and if you smoke. Also of course, your height, weight, and the calculation of your BMI.

Maybe someone has the actual form, but for me that's how it was done. My doctor registered on the site, printed the form, we completed it, and she faxed it into the registry. Its a very basic form.

Thanks Jennifer..My Dr has submitted the form, but I wasn't there..we went over my health, t etc then he completed it when I left and faxed it in. My first request was denied because I have a gastric band and I wanted to see exactly what the wording is related to "previous bariatric surgery" that is on the form.

I don't even remember her asking me if I had had any previous WLS, I haven't, but I bet that would also be on the referral form. That's odd, I thought I had read revision from band was covered, and found the below on obesity helps, in another post, maybe ask your doctor to do a bit more research. Just the wording in your last post, how your doctor said 'the band is not insured' seems as though he misunderstood, or requested the wrong thing. You are looking for band removal to RNY conversion, correct?  Anywho, the below is the info I read on here, the link is the post it came from, Good luck to you!  Don't give up!:

"The removal of a gastric band is covered by OHIP when there are complications, so the doctor who said there is no code spoke an untruth (and if you have his name i'd suggest making an official complaint either to the hospital ombudsman or the college of physicans and surgeons for speaking without knowing what he was talking about).  

"Here is the OHIP code (which took me all of 5 minutes to find) and wording about gastric band removal. 

S113 Removal of gastric band .......................................................... 7 300.00 10 Note: S113 is only eligible for payment when the gastric band requires removal due to: i. Complications related to the gastric band; or ii. Conversion to gastric bypass"

http://www.obesityhelp.com/forums/on/4012193/Anyone-had-banding-in-Hamilton-that-OHIP-covered/

Good luck to you!  Don't give up!