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Copy goes hereStephen G. Boyce, MD, FACS K. Robert Wil iams, MD CONSULTATION APPOINTMENT
Please make these preparations for your 1st appointment with your surgeon. 1. Complete steps 1-3 on the Coversheet Checklist 2. We will need to perform some tests to evaluate and prepare you for surgery. The cost of these is in addition to your consultation. Do not take any Antibiotic, Pepto-Bismol or Proton Pump inhibitors 14 days prior to your visit with us. Proton Pump inhibitors include, but are not limited to, Nexium, Prilosec, Prevacid, Protonix and Aciphex. If you usually take any of the medications above, please switch to a histamine-2 (H2) Blocker during this time. These include Axid (nizatidine), Pepcid (famotidine), Tagamet (Cimetidine), and Zantac (ranitidine). If you do not take any medications for acid reflux, then follow instructions in # 3 only. 3. Do not take anything by mouth 4 hours prior to your visit. This includes coffee, water, coke and diet coke products, any type of food and tobacco. If you do not have insurance you will be asked to cover the cost of the test before it is performed. Depending on the tests ordered for you and the type of insurance you have, you may need to pay toward the testing prior to us performing the test. Pages 18-20 of this packet are for information on how our practice operates. Please review them prior to your first appointment with our office. After your consultation appointment, you will begin obtaining labs, tests and clearances as ordered by your surgeon and/or required by your insurance. This may include 6 months of Medically Supervised Dieting. We will help you arrange getting started if needed. In order to complete your application for the program, we request a letter from either your primary care physician or an internal medicine physician. This medical clearance by an independent physician is an important step that can be helpful for getting insurance pre-approval for the surgery, but more importantly, this helps to ensure that you have comprehensive medical care before, during and after your surgery. We will need your Primary care physician’s office notes including records that list your weight each year, for the past 5 years. We will also need all records from any medically supervised diet you have completed. These records need to include visit dates, weights, Blood Pressure and Pulse (if taken), and any instruction, guidelines, or information given to you at each visit. All patients will need to have a psychiatric evaluation done prior to surgery. If you already have a relationship with a psychiatrist or psychologist, please ask them to provide Stephen G. Boyce, MD, FACS K. Robert Wil iams, MD you with a letter stating your clearance for weight loss surgery. You do not need to have it completed before your visit with the surgeon, just before we send your information to the insurance company for approval. If you do not have a psychiatrist or psychologist already, we can assist you in getting scheduled with one and will do this on the day you come to see the surgeon. If you have other medical specialists that you see regularly, a letter of clearance for weight loss surgery is advisable. Since it may take some time to obtain this, you may want to go ahead and request it.
Pasaporte-RUT: Nacionalidad: Fecha de Nacimiento: Teléfonos: Correo electrónico: Título: Institución: Departamento de Psiquiatría y Salud Mental Oriente Facultad de Medicina, Universidad de Chile 1994 - 2001: 2001 – 2004: Hospital del Salvador, Universidad de Chile 2003 – 2005: Hospital del Salvador, Santiago de Chile 20