№ lp_1_2_20438
Structured NHS clinical referral document defining eligibility, exclusion criteria, required clinical data, and patient and referrer confirmations for access to a Tier 3 weight management pathway.
Document type: Referral form
Programme level: Tier 3 weight management
Eligibility criteria version: QOQ_20250821_v3.0
Health system: NHS
Referring authority: Integrated Care Board
Referrer type: General Practitioner
Patient age requirement: 18 years and over
BMI thresholds: ≥50 kg/m2; ≥40 kg/m2 with prior conservative management; ≥35 kg/m2 with comorbidities and prior conservative management
Adjusted BMI criteria: Reduced by 2.5 kg/m2 for specified ethnic groups
Included comorbidities: Hypertension; hyperinsulinaemia; dyslipidaemia; type 2 diabetes; psychosocial dysfunction; asthma exacerbation
Exclusion criteria: Pregnancy; breastfeeding; uncontrolled cardiovascular disease; active eating disorders; active cancer; unstable mental illness; substance misuse; endocrine instability; prior bariatric surgery; previous Tier 3 programme participation
Required assessments: Weight; height; BMI; HbA1c; blood pressure; renal function; lipid profile; thyroid function
Submission method: Secure NHS mail or e-RS
Referral destination: [email protected]
Price: 8 / 10 USD
The file will be delivered to the email address provided at checkout within 12 hours.

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