Make a Referral
A Referral is required to begin the program entry process.
We encourage patients to view our online Bariatric Seminar to see if bariatric surgery is the right treatment option for them.
Dear Referring Provider Letter PDF
To refer for a NEW EVALUATION for BARIATRIC SURGERY (NON-URGENT), please complete the SOBC Referral Form and fax to 541-248-4808
All referrals must include:
- Completed REFERRAL FORM, acknowledging patient meets minimum referral criteria
- Recent CHART NOTE documenting diagnosis of obesity and patient interest in bariatric surgery
- Demographics and Insurance information
- Problem list
- Current medication list
- Additional documentation as indicated based on reason for referral (see Referral Form)
- Negative urine cotinine (only needed if nicotine quit date is within past 12 months of referral date)
If patient is experiencing NON-URGENT, ACUTE ISSUES RELATED TO A PRIOR BARIATRIC SURGERY (ex. inability to eat/drink, persistent nausea/vomiting, abdominal pain), DO NOT USE THIS FORM. REFER DIRECTLY TO OREGON SURGICAL SPECIALISTS.
Patients who are 100 pounds or more overweight, or 75 pounds overweight with obesity-related conditions could benefit from surgical intervention to help them lose excess weight and help maintain weight loss for life. American Society for Metabolic and Bariatric Surgery: https://asmbs.org/patients/who-is-a-candidate-for-bariatric-surgery
We use research-driven guidelines to help us determine which candidates are best suited for bariatric surgery.
Criteria for Candidates for our Bariatric Surgery Preoperative Program
Entry into the SOBC program will be considered for patients who meet the following minimum criteria AND for whom bariatric surgery would not be associated with excessive risk:
- For new evaluation – patient with no history of prior bariatric surgery (for those seeking conversion- see Referral Form for instructions)
- Age 21-75
- BMI criteria
- BMI ≥ 40
- BMI ≥ 35 with at least one obesity-related condition (ORC)
- If current BMI > 70, we request patients begin working with their current providers and available resources to actively promote a downward trend in BMI before being referred to SOBC.
- BMI ≥ 40
- Nicotine-free (no use of ANY nicotine, includes smoking, vaping, patches, gum, chew).
- Active nicotine use is a contraindication to bariatric surgery. Nicotine use significantly increases the risk for short-term and long-term post-operative complications.
- PLEASE DO NOT REFER IF PATIENT IS AN ACTIVE NICOTINE USER. ONCE PATIENT IS NICOTINE FREE, OBTAIN A URINE COTININE TEST. A NEGATIVE TEST RESULT IS NEEDED TO PROCESS THE REFERRAL for any patient with a history of nicotine use in the past 12 months.
- NO unstable mental health or behavioral health conditions.
- NO illicit drug use in the past 2 years.
- NO alcohol abuse or misuse in the past 2 years.
- NO self-harm or suicide attempt in the past 5 years.
Bariatric surgery is an elective procedure and does not go without risk. Patients with UNSTABLE diagnoses (cardiac, pulmonary, psych, etc.) cannot safely begin the bariatric surgery journey. Examples of unstable conditions include frequent or recent ED visits or hospitalizations related to their diagnosis. Once a patient is considered medically stable, please complete the Referral Form.
All candidates are evaluated on a case-by-case basis prior to program entry, and on-going to determine suitability and risk/benefit to undergo bariatric surgery including:
- Well-managed medical conditions
- Well-managed mental/behavioral health
- Willingness and ability to commit to lifestyle, eating and cognitive behaviors to support health and weight loss maintenance
- Supportive social environment
Referrals for a Patient with a History Of Bariatric Surgery
For referrals for patients with a history of bariatric surgery that meet the following criteria:
- Patients with a suspected surgical problem (ex. inability to eat, persistent nausea/vomiting). If patient is having an urgent concern, please direct patient to Emergency Room at Asante Rogue Regional Medical Center (if possible). ARRMC is our partner in providing care to patients with bariatric surgery emergencies.
- If patient is experiencing NON-URGENT, ACUTE ISSUES RELATED TO A PRIOR BARIATRIC SURGERY. REFER DIRECTLY TO OREGON SURGICAL SPECIALISTS https://www.oregonsurgical.com/providers/
- Patients requesting/seeking revision or conversion of a prior bariatric surgery procedure (ex. adjustable gastric band removal, conversion from sleeve to bypass, etc.) complete the Referral Form.
- Patients requesting to re-establish routine post-operative long-term follow-up with SOBC: Previous SOBC patients ONLY. Due to capacity limitations, we are not able to accept referrals for routine post-operative follow-up for patients who did not have bariatric surgery through SOBC. Please refer these patients back to their original program/surgeon for long-term follow-up care.
After we receive your referral, our program entry team will:
- Confirm patient meets minimum criteria for program entry
- Invite your patient to view our online Bariatric Seminar. The seminar is open to all, and viewing is encouraged before beginning the referral process.
- Provide your patient with instructions to access the Bariatric Seminar Quiz and submit New Patient Paperwork Forms. Due to limited capacity, we cannot give access to new patient forms until a referral is accepted (patient appears to meet minimum criteria).
After your patient submits New Patient Paperwork Forms we will:
- Verify bariatric surgery insurance benefit. Not all insurance plans cover bariatric surgery. We will determine any insurance-based requirements that must also be met to be considered a bariatric surgery candidate. Even if a patient qualifies medically for bariatric surgery, insurance requirements or coverage may limit bariatric surgery as a treatment option. For certain patients (evaluated on a case-by-case basis), cash-pay options may be available.
- Conduct a clinical and medical record review
- Schedule your patient for an Orientation (currently this is an interactive, virtual group) . This is an overview of your patient’s individual insurance requirements, and the next steps to begin the SOBC pre-surgery program.
- After the Orientation, your patient can then choose to schedule the first SOBC office visit to establish care with our Providers.
- For more information, please refer to our seminar for specific program information, program fee and requirements.
Long Term Follow-Up Care
For patients whom have had bariatric surgery through SOBC, our clinicians will continue to reach out and follow that patient long-term, for life. Post-operative routine follow-up occurs at 2 weeks, 1 month, 3 months, 6 months, 12 months, then annually thereafter.
Our providers will order routine lab tests and continue to counsel/support patient in adipose loss/maintenance of lean body mass and weight maintenance behaviors.
Metabolic/Bariatric Surgery Overview and Effectiveness Research (published October 2018)
Bariatric Surgical Risk Calculator
Tool to aid in conversation about risk vs. benefit of bariatric surgery
Obesity Medicine Association
Pocket guides available for managing the post-operative bariatric surgery patient.
Bariatric Surgery Guidelines and Recommendations: Position Statements