Sample Letter of Support

[breekahouse 2]

Hi all.

I am getting closer to receiving a surgery date. the only things left for me to do is have an endoscopy (februar 3rd) and have my PCP sign a letter of support.

Does anyone have a sample that I can use?

Thanks!

[MINI-Me 196]

Hopefully this will help. My letter was very simple - they just attached it to my labs and post op exam notes (on clinic letterhead):

Dr. _________:

After post op exam on ________, Sally Jane, DOB xx/xx/xx, is cleared to proceed with surgery for a gastric sleeve.

Sincerely,

Dr. Smith

xxx-xxx-xxxx

[breekahouse 2]

Thanks MINI-Me but I think what I need is some a little more formal which states facts about my history, comorbidities and reasons why my PCP feels that i am a good candidate for WLS.

Thanks again for repsonding to so fast!

[MINI-Me 196]

Sorry - My doctor just did this simple letter & attached all the records. Hopefully someone else out there has a different example. Best of luck!

[Tiffykins 673]

Hope this helps:

Re: Ms. XXX (your name)

DOB: Your date of birth

Dear Sir or Madam:

I have been seeing Ms. XXX as a patient since April 29, 2005 and trying to deal with her morbid obesity with diet and exercise programs. With her medical problems and lack of success with any significant weight loss, I am referring her to Dr. Bariatric for weight reduction surgery evaluation. Ms. XXX's height is 5’5” and her weight is 282 lbs making her BMI 46. To my understanding this alone should qualify her as a candidate for the procedure. In addition to morbid obesity, the patient is suffering from low back pain, exertional dyspnea, bilateral lower extremity edema, and headaches. She has already tried numerous weight loss/exercise programs without success including physician monitored weight loss programs w/ medications as well as Weight Watchers Program and other noted programs. She also has a strong family history of hypertension, diabetes, and heart disease. I am respectfully requesting pre-authorization for bariatric surgery to include the patient’s benefits and coverage. We will send the accompanying documentation. Hopefully, Dr. Bariatric will be able to help her with your assistance.

Sincerely,

Doctor Name and Signature

Doctor's Practice name, address, and phone number

[breekahouse 2]

Tiffy, you frickin' rock! this is exactly what i wanted but could not effectively communicate. you are the best! thank you sooooooooooo much!

[Tiffykins 673]

Glad it helped ! ! ! I wish the best of luck getting these last steps taken care of, and we'll be waiting for on the loser's bench.

Tiffy, you frickin' rock! this is exactly what i wanted but could not effectively communicate. you are the best! thank you sooooooooooo much!