№ files_lp_4_process_2_77179
File format: docx
Character count: 4800
File size: 4321 KB
Clinical referral form outlining eligibility criteria, patient information fields and required clinical measurements for enrolment of adult patients into the Oviva T3 NHS weight management programme.
Version:
QKK_20250701_v1.0
Document Type:
Referral Form
Programme:
Oviva T3 Weight Management Programme
Healthcare System:
NHS
Organisation:
National Health Service (NHS)
Referral Source:
General Practitioner (GP)
Eligibility Age Requirement:
18 years and older
Clinical Criteria:
BMI thresholds with specified comorbidities
Exclusion Criteria:
Pregnancy, active cancer, recent bariatric surgery, severe mental illness, uncontrolled conditions and other listed medical factors
Required Clinical Data:
Weight, height, BMI, HbA1c, blood pressure, renal function, cholesterol levels, thyroid function, liver function, QRISK2 score
Patient Data Fields:
Name, date of birth, gender, ethnicity, NHS number, contact details, address
Referral Submission Method:
NHS secure email or e-Referral Service (e-RS)
Intended Users:
General Practitioners within the NHS
Price: 8 / 10 USD
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The product description is provided for reference. Actual content and formatting may differ slightly.
Year:
2025
Region / City:
Not specified
Topic:
Healthcare, Obesity Treatment
Document Type:
Referral Form
Organization:
Oviva
Author:
Not specified
Target Audience:
Healthcare professionals, General practitioners (GPs)
Period of Validity:
Not specified
Approval Date:
Not specified
Modification Date:
Not specified
Year:
2025
Note:
Region / City
Theme:
Healthcare, Obesity Management
Document Type:
Referral Form
Institution:
NHS
Target Audience:
Healthcare professionals, General Practitioners
Year:
Not specified
Region / City:
Not specified
Subject:
Weight management, Type 2 diabetes, Clinical referrals
Document Type:
Referral form
Organization / Institution:
NHS
Author:
Not specified
Target Audience:
Healthcare professionals, General practitioners
Period of validity:
Not specified
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
2016
Region / City:
Canberra
Theme:
Neonatology, Premature Infant Care
Document Type:
Guideline
Institution:
Canberra Health Services
Author:
Department of Neonatology
Target Audience:
Clinicians (Medical Officers, Registered Nurses, Registered Midwives, Students)
Effective Period:
Ongoing
Approval Date:
Not specified
Revision Date:
Not specified
Year:
2025
Region / city:
Not specified
Topic:
Weight management, eligibility criteria
Document type:
Referral form
Organization / institution:
NHS
Author:
Not specified
Target audience:
Healthcare professionals (GPs, clinicians)
Period of validity:
Not specified
Approval date:
Not specified
Date of changes:
Not specified
Year:
2016
Region / city:
N/A
Topic:
Weight and balance of aircraft for LSA certification
Document Type:
Guideline
Organization / institution:
N/A
Author:
N/A
Target audience:
LSA certification applicants
Period of validity:
N/A
Approval date:
N/A
Revision date:
N/A
Year:
2022
Region / city:
Rome
Theme:
Persistent Organic Pollutants
Document type:
Technical report
Organization / institution:
United Nations Environment Programme (UNEP)
Author:
Secretariat of the Stockholm Convention
Target audience:
Stakeholders in environmental protection and chemical safety
Period of validity:
N/A
Approval date:
20 August 2022
Date of changes:
N/A
Year:
Semester:
Note:
Region / City
Topic:
Physical Education, Fitness
Document Type:
Self-Reflection, Progress Report
Author:
Eva Stryukova
Target Audience:
Students, Educators
Period of Effectiveness:
End of Semester
Contextual Description:
A self-reflection document by a student outlining progress and achievements in a weight training course, including personal growth in fitness, exercise techniques, and health management.
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]
Document type:
Referral form
Eligibility criteria version:
QKK_20250821_v2.0
Healthcare system:
NHS
Country:
United Kingdom
Issuing body:
NHS
Intended use:
Clinical referral
Target population:
Adult patients with obesity
Age eligibility:
18 years and over
Clinical focus:
Obesity and related comorbidities
BMI thresholds:
≥40 kg/m2 or ≥35 kg/m2 with qualifying criteria
Ethnic adjustment:
Reduced BMI threshold for specified ethnic groups
Exclusion criteria included:
Yes
Referrer requirement:
Named GP only
Required clinical measurements:
Weight, height, BMI, HbA1c, blood pressure, renal function, lipid profile, thyroid function
Associated therapy:
GLP-1 therapy
Submission method:
Secure NHS mail or e-RS
Contact email:
[email protected]
Year:
2023
Region / city:
United States
Subject:
Weight Management
Document Type:
Medical form
Organization / institution:
Microsoft
Author:
Not specified
Target Audience:
Microsoft employees and their covered dependents
Effective Period:
Not specified
Approval Date:
Not specified
Amendment Date:
Not specified
Year:
2025
Region / City:
Humber and North Yorkshire
Topic:
Weight Loss Medications
Document Type:
FAQ
Institution:
Humber and North Yorkshire Integrated Care System (HNY ICB)
Target Audience:
Clinicians, Healthcare Providers
Period of Effect:
2025
Approval Date:
June 2025
Amendment Date:
TBD
Year:
2026
Region / City:
Australia
Topic:
Body mass management in athletes
Document Type:
Guideline
Organization:
Rowing Australia
Author:
Rowing Australia
Target Audience:
Athletes, coaches, performance support staff
Period of Action:
Ongoing
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
Not specified
Region / City:
Not specified
Subject:
Weight management, Type 2 diabetes, Clinical referrals
Document Type:
Referral form
Organization / Institution:
NHS
Author:
Not specified
Target Audience:
Healthcare professionals, General practitioners
Period of validity:
Not specified
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
2024
Region / City:
Massachusetts
Topic:
Healthcare / Drug Coverage
Document Type:
Newsletter
Organization / Institution:
MassHealth
Author:
MassHealth Drug Utilization Review Program and the MassHealth Pharmacy Program
Target Audience:
Healthcare providers, MassHealth members
Period of Action:
From October 2024 to January 2025
Approval Date:
October 2024
Date of Changes:
October 2024
Contextual Description:
A newsletter detailing upcoming changes in MassHealth coverage for anti-obesity medications, including the introduction of Zepbound® (tirzepatide) as a preferred drug and updates to prior authorization requirements.
Note:
Year
Topic:
Physics, Mechanics
Document type:
Educational material
Target audience:
Students
Year:
Not specified
Region / city:
Not specified
Topic:
Forensic Science
Document Type:
Examination Subject Outline
Institution:
Not specified
Author:
Not specified
Target Audience:
Criminology students and professionals
Effective Period:
Not specified
Approval Date:
Not specified
Date of Changes:
Not specified
Note:
Year
Theme:
Social and Economic Data Analysis
Document Type:
Instructional Manual
Organization / Institution:
U.S. Census Bureau
Target Audience:
Data Analysts, Researchers
Year:
2019
Region / City:
United States
Topic:
Supplemental Security Income (SSI) Eligibility
Document Type:
Government Report
Agency / Organization:
Social Security Administration (SSA)
Author:
Social Security Administration
Target Audience:
SSI recipients or their representative payees
Period of Validity:
Not specified
Approval Date:
Not specified
Modification Date:
Not specified
Year:
2011
Region / city:
United States
Document type:
Government report
Organization / institution:
Department of Veterans Affairs
Author:
Department of Veterans Affairs
Target audience:
Veterans, service personnel, and their dependents/beneficiaries
Period of validity:
Annual
Approval date:
May 11, 2011
Date of amendments:
None
Number of respondents:
219,000 per year
Frequency of response:
Annually
Total estimated cost to respondents:
$1,696,125
Total estimated cost to the government:
$3,555,672