Submit this form ONLY after deposit has been received.
Patient Coordination Checklist:
1. Check pricing matches:
✓ Procedure type
✓ BMI (High BMI = >49.4, Double = >59.4)
✓ Doctor
✓ Extras (i.e. Revision, Endoscopy w/LapBand Removal, Latex, Financing Fee, Pain Meds, and etc.)
2. Check availability calendar:
✓ Hospital Shows Open (SER shows an opening or Obesity does not show Closed)
✓ Doc does not show Closed
3. Confirm patient can see Doc selected (i.e. Cardiac=Perez/Green only, Cueva no High BMI/Major Contraindications)
4. Must double check for accuracy:
✓ Amounts
✓ Dates
✓ Deposit notes (if different name or method note)
✓ Travel Requirements
5. Please double check pre-op requirements and diet length are checked on AC chart.