Six month documentation

PHYSICIAN PROGRESS NOTE FOR WEIGHT LOSS ATTEMPTS

PATIENT:  YOUR NAME HERE

Date:                July 17, 2006  (Separate sheet for each month.) 

Weight:            350+ lbs.  Unable to obtain due to scale capacity)

                        Weighed at XXXXXXX on 6/21:  386 lbs.

Type of Diet:  What kind? Weight loss using American Diabetes Association Guidelines, American Heart Association, Weigh****chers, Low Fat.

Exercise:          Moderate walking daily.  (Other possible comments: Problem walking & standing due to arthritis & weight.)

Diet Pills:          None. (List kind if pills are used.)

Behavior Modifications Discussed:  Continue written food diary.  Watch portions. 

Additional Comments: (0ptional) Sample of what I used:  Patient has continued to schedule testing & consultations for bariatric surgery approval. 

                                                Signature_____________________________

                                                                                    XXXXXXXXXXX, M.D.