*Patient Selection*
Choose
Choose site
BH
CGH
DH
ERH
FCH
LMH
PAH
RCH
RMH
JPOC (SMH)
Yes
No
Yes
No
Gender:
Yes
No
cm
kg
"Electronically Signed"
Stamp Sig
Wet Sig
Electronic Sig
▲
▼
▲
▼
▲
▼
Refer for
weight management
only if there are nutrition-related co-morbidities.
Refer diabetic patients directly to
Diabetes Education Centre
.
Appropriate referral topics:
Hyperlipidemia *
Overweight issues *
Adult/Adolescent eating disorders
Failure to thrive (pediatric and adult)
Pediatiric obesity
Hypertension
IBD and other GI disorders
Metabolic diseases requiring diet modification
High risk pregnancy
Kidney stones
Liver or kidney diseases
Food allergies
* Nutrition education classes available at some sites
Close
Subject:
FHA Outpatient Nutrition Counseling Referral eForm, update V3_Feb15_2021, by Dr. John Yap for OscarBC, is licensed under a
GPL
.
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