PHYSICIAN USER'S Guide to the New Online Bariatric Referral
Contents
1. My Details OHIP Billing Office Clinic Name Primary Practice Address City Province Ontario Postal Code Office Clinic Phone Ext Secondary Phone optional Ext Fax Secondary Fax optional U hereby certify that the information above is true and accurate U As the referring physician agree to work in partnership with the bariatric clinic to provide my patient with the necessary medical care and support throughout the course of his her bariatric treatment Select Yes to confirm Confirmation Are you sure you want to create an account E The following message will be displayed select Ok Success successfully created your account An email has been sent with instructions to activate your account Ok You will receive an email from the Bariatric Referral System with your unique username and temporary password From Bariatric Referral mailto donotre Sent March 25 15 4 33 PM Subject BARIATRIC REFERRAL PORTAL CONFIDENTIAL Website Account Activation Importance High Sensitivity Confidential Hello New User Your account has been activated for the BARIATRIC REFERRAL PORTAL system Your username and a temporary password are as follows User Name i_testinb2 Password Gs3m2 YQ In order to access the system please click the following link https localhost BanatncReferral You will be mstruicted to enter the password provide2. If you continue with the referral after receiving an ineligibility message your patient will be deemed ineligible for all bariatric programs Bariatric Referral Form Your patient is ineligible for the Ontario Bariatric Programs currently offered Your patient does not currently meet the eligibility criteria requirements for the Ontario Bariatric Programs funded by the Ministry of Health and Long Term Care MOHLTC Please seek programs within your local community Cancel Save and Exit Warning Messages The second type of error message is a warning message Unlike ineligibility alerts which signal the end of the referral process a warning message will enable you to continue with the referral process but limits your patient s eligibility to certain programs Warning Your patient is currently ineligible for the Surgical Program Please re refer your patient following 6 months of controlled treatment However your patient may be eligible for referral to the Medical Program Please continue with the referral process if this is a desired option After you click away from the pop up with the warning message this message is displayed on screen for further reference 3 Does your patient have a history of a major cardiovascular event within the last 6 months No Yes WARNING Your patient is currently ineligible for the Surgical Program Please re refer your patient following 6 months of controlle
3. from the Action Items drop down menu to the left of that user s name on the main users table Action Status Username Role Location Actions Active Physician Delegate Edit Physician Remove Security Role Displaying 2 of 2 You will then be asked to confirm that you want to remove the user s security roles to the new bariatric referral system Confirm Are you sure you want to remove this user s Bariatric Referral security roles ia Once you have confirmed that you would like to remove the security roles the user s account is locked i e deactivated or rendered inactive These will still remain in the system and will show up when you filter your users list to show only locked users Remember the default view for the users list table is to show only active users In order to re activate an account where the security roles have been removed please contact PHRI at bariatricreferral techsupport phri ca
4. if it is the same Physician as first discharged referral they will see both discharged and submitted referrals in their list Upon submission the re referral will be assigned a new ID number and the patient s previous referral history will be linked to the referral re submitted into the system My Referrals Submit New Referral Action Status Details Patient Referral Acti Submitted This referral has been successfully submitted and the 9876 543 217 002100041 elcid centre has been notified for scheduling No action is Surgical Program ene St Joseph s Healthcare Hamilton Submitted 2015 03 06 rina Discharged This referral has been discharged for the following 9876 543 217 002100040 reason insert reason for discharge selected by the Surgical Program centre St Joseph s Healthcare Hamilton Submitted 2015 03 05 When the centre user selects referral history on the new re referral they have the option to view past referral and past referral history Referral History Submitted By Referral ID 002100041 Patient Name Bariatric Program Type Surgical Program Centre Assignment St Joseph s Healthcare Hamilton Status Submitted Date Referral Submitted yyyy mm dd 2015 03 06 Comments Transfer History Type Date From To Back View Referral gt View Past Referral Past Referral History lt a Body Mass Index BMI The next page of the referral form asks y
5. however patients will be responsible for their own travel arrangements and expenses Residents of Northern Ontario may be eligible for the Northern Health Travel Grant NHTG Program to help with travel related costs After you have selected the bariatric program that you want to refer your patient to you will be directed to a new page Patient Information for Centre Allocation After you have selected the bariatric program that you want to refer your patient to you will be directed to a new page where you will be asked to provide some patient information to aid in assigning your patient to a bariatric treatment centre Patient Information for Centre Assignment Please indicate the Edmonton Obesity Stage of Choose a Score p your patient using the EOSS guide First Name Last Family Name Address City Province Country Ontario Canada Postal Code A1A 1A1 Phone Number Type Choose a Phone Number Type v Secondary Phone Number Optional Type Choose a Phone Number Type v Email Optional Additional Comments EOSS Score You will be asked to calculate your patient s Edmonton Obesity Staging System EOSS score Developed by Dr Arya M Sharma and Dr Robert Kushner this 5 stage system enables clinicians to rank their patient s underlying health and functional status as well as the presence and severity of underlying obesity related comorbid conditions The score is based ona series of simple criteria including you
6. o First Name Last Family Name Specialty O Primary Care Physician O Medical Internist O Nurse Practitioner z O Family Physician O Specialist please specify O Other please specify If Specialist or Other please specify Office Clinic Name Office Clinic Address ON Ontario City Province Postal Code Office Clinic Phone Number Ext Secondary Office Clinic Phone Number Ext Office Clinic Fax N Secondary Office Clinic Fax Number Email Address Cl authorize the creation of a user account using the supplied credentials OI hereby certify that the information above is true and accurate O Iam responsible for this account and accountable for all referrals submitted Referring Provider Signature Date YYYY MM DD This is beneficial for physician offices who do not have computers in their exam rooms or for clinics that have a high patient volume PLEASE NOTE This worksheet has been provided for reference purposes only and is not a valid referral form Any referral worksheets faxed into the old bariatric referral fax number will not be processed and returned to sender The last page of the referral form worksheet collects the information necessary to register for a physician account This must only be done one time by the physician The Referral Form The referral form is a series of clinical questions that are used to assess patient eligibility to one or more of the bariatric treatme
7. Referral ID 002100041 Bariatric Program Type Surgical Program Centre Assignment St Joseph s Healthcare Hamilton Date Referral Submitted 2015 03 06 Patient Information Patient Name Full Address Primary Phone Mobile Secondary Phone Email Address Patient Health Card 9876 543 217 Date Of Birth 1975 05 08 Sex Female BMI 59 kg m Eoss Stage 1 Alerts Additional Comments Physician Information OHIP Billing Physician Name Full Address Office Phone Fax Email Address Question 1 Does your patient currently have a problem with alcohol and or drugs No 2 Does your patient have a recent history of major life threatening cancer within the last 2 years No 2a Is your patient currently undergoing active treatment for this cancer e g chemotherapy radiation N A 3 Does your patient have a history of a major cardiovascular event within the last 6 months No Referral History For patients who have had more than one referral the Referral Actions drop down menu also provides a link to the patient s referral history The patient s referral history also tracks any transfers that may occur e g across centres between programs or for surgery only Referral History Submitted By Referral ID 002100041 Patient Name Bariatric Program Type Surgical Program Centre Assignment St Joseph s Healthcare Hamilton Status Submitted Date Referral S
8. Yes Complicated type 2 diabetes mellitus is defined as having at least 1 of the 4 following conditions that persists despite adequate management efforts Please check any that apply if known Metabolic lability or instability Retinopathy D Nephropathy J Cardiovascular disease 8 Does your patient have hypertension 2 No Yes 8a Is your patient s hypertension poorly controlled O No Yes 9 Does your patient have idiopathic intracranial hypertension No D Yes 10 Does your patient have diagnosed sleep apnea No J Yes 11 Does your patient have gastroesophageal reflux disease GERD No D Yes 12 Has your patient attempted weight loss in the past without successful long term weight reduction No Yes ESE Cancel Save and Exit The answers to these questions will be used to assess eligibility to one or more of the bariatric programs currently offered Bariatric Referral Form 13 Does your patient have end stage renal disease No Yes 13a Does your patient require dialysis No O Yes 13b Does your patient have a transplant O No Yes 13c Does your patient require a transplant No Yes 14 Has your patient had bariatric surgery previously No Yes 14a My patient s previous bariatric surgery was performed In Ontario Out of country or out of province 14b My patient is now seeking Further bariatric surgery Revision or conversion of a previou
9. Yes to confirm Confirmation Are you sure you want to create an account The following message will be displayed select Ok Success successfully created your account An email has been sent with instructions to activate your account Ok You and the Physician s will receive an email from the Bariatric Referral System with your unique username and temporary password From Bariatric Referral mailto donotreply phri ca Sent March 25 15 4 33 PM Subject BARIATRIC REFERRAL PORTAL CONFIDENTIAL Website Account Activation Importance High Sensitivity Confidential Hello New User Your account has been activated for the BARIATRIC REFERRAL PORTAL system Your username and a temporary password are as follows User Name i _testinb Password Gs3m2 YQ In order to access the system please click the following link https localhost BanatncR eferral You will be instructed to enter the password provided and change your password on first login Regards PHRI Project Office Once the email is received return to https referrals ontariobariatricnetwork ca Enter your username and temporary password and select Sign In ONTARIO Bariatric Network Sign in to continue to the Referral Portal Username Email Username Email Password a Password The system will display a message that your password has expired select Ok Bariatric R
10. office workers Search Action Status Username Name Role Location Email Actions Active Physician Delegale Sorting Options Email Actions Active Physician First Name Actions v Active Physician Last Name A Location Displaying 3 of 3 Role Username E Page Size 30 Filters Status O Active O Locked Role O Physician D Physician Delegate Searching Sorting and Filtering User Accounts As with the referral queue you can search sort and filter user accounts Searching User Accounts To search across your list of users you can enter one of the following parameters into the search box e First and or last name e Username e Type of user role and e Email address Search Sorting User Accounts To sort your list of referrals select one of the sorting options to the left of My Referrals The list of sorting options is below the search box which is on the left hand side of your My Referrals screen Sorting Options Email First Name Last Name A Location Role Username You can sort by e Email address A Z Z A e First name A Z Z A e Last name A Z Z A e Location A Z Z A e Role or user type ascending descending and e Username A Z Z A At any time you can revert back to the default view setting viewing all users sorted alphabetically by last name by hitting the Reset button which is
11. 9 e Safari If you are not using one of these browsers we strongly suggest downloading and installing the latest version of Google Chrome Registering for an Account Eligible healthcare providers must first register for an account before referring a patient to one of the Ontario Bariatric Programs Registering is quick and easy and must only be completed once To register you will be asked for some basic information e OHIP billing number and e Contact information e g name address email clinic phone and fax numbers Registering as a Physician Please use the following instructions only if you have an OHIP Billing Number Family Physician Primary Care Physician or Specialist a Navigate to https referrals ontariobariatricnetwork ca and select Register here from the Bariatric Referral landing page Need an account Register here Select your role from the I am a drop down list Registration lam a Choose a Specialty v Choose a Specialty Primary Care Physician Medical Internist Family Physician Specialist please specify Nurse Practitioner Other please specify Medical Office Assistant Enter your title optional first name last name and email Registration l am d Primary Care Physician Title First Name Last Name Email Complete the My Details section of the registration form and select Register
12. Bariatric Network s website e Surgical Program http www ontariobariatricnetwork ca our programs surgical program e Medical Program http www ontariobariatricnetwork ca our programs medical program In consultation with your patient you will select the program that best suits your patient s wants and needs Here are some brief descriptions of each program Surgical Program Bariatric Referral Form Your patient is eligible for the Bariatric Surgical Program Refer my patient to the Bariatric Surgical Program Back Cancel Save and Exit The Surgical Program is offered at all 9 of the bariatric treatment centres This program provides pre and post surgical care of morbidly obese patients Patients attend an orientation session and are comprehensively screened and assessed by the Centre s interdisciplinary team to assess appropriateness for surgery Intensive education and nutritional counselling is also provided Post surgical follow up is routinely scheduled for a period of 5 years Funded procedures include Roux en Y gastric bypass vertical sleeve gastrectomy and biliopancreatic diversion The type of surgical procedure undertaken depends on existing conditions and surgeon assessment as well as in discussion with the patient Patients who have met the referral criteria are assessed at their assigned Bariatric Centre of Excellence BCoE or Regional Assessment and Treatment Centre RATC Centre a
13. PHYSICIAN USER S GUIDE TO THE NEW ONLINE BARIATRIC REFERRAL eee This guide will help physicians an d physic iE legate avigate the new online referral system for bariatric programs in the Pro E es Table of Contents BYE OCU UI cece E casa tececeresenenaneneeeencacncnenenses 1 The Purpose of a New Online Bariatric Referral System 0 000 2 Benefits of the New Referral System for Physicians and Other Referring Healthcare Provide rs ccccseccesceseeescecceseeeeeeceeseeseeeseusenss 2 Technical Specifications ccccccceccesceececcuseeceeeceuseeeeeeeeeseueeseesseneensss 3 Registering for an ACCOUNT ccccccecscscscscsceccccccccccccccececscncns 3 Registering as a Physician anuunssnenastnesansseasamneeeanomuuneeteasasansansseuedniestecnee 3 Registering as a Non Physician User Physician Delegate 000 8 Logging In to the New Online Bariatric Referral System 12 Logging in as a Physician Delegate ccccceccsecceseeseesseeseeseeeseeseeeees 13 Forgot Password cecceeccecceseeeccuseeseeeseuceeseeeeeceuseeeeeeseuseesteeseeseeees 15 Physician Dashboard s ssessessesescescescecoecescescescesoessesesceesee 15 PUCTIOWY ONE earan EE E EE E E E E E IE E 16 INOUE CA OM Stanaserscecenebacnnasnrscocvennenasesscocvobacsnasenicocvoratnesniuccvoriceeace 16 Patient Information Updated c scsssssscssscsssssecsssssscsssscsesssecsssssscassnesesssecassntseasenessasees 18 Referral S
14. adian guidelines and recommendations for optimal bariatric care Additional instances of this symbol across the referral process link to descriptions of the Ontario Bariatric Programs offered Health Card and Date of Birth The first page of the referral form asks for three pieces of information your patient s e Ontario Health Card number or information about other recognized provincial federal healthcare funding e Date of birth and e Biological sex Bariatric Referral Form New Referral Health Card Version Code 0000 000 000 AA J My patientis a resident of Ontario but does not have an Ontario Health Card Birthdate Sex Male Female Cancel Save and Exit Patients must be over the age of 18 to be referred using this system If your patient is under 17 5 years of age a pop up warning message will appear directing you to alternative treatment options for pediatric patients Ineligible Patients under the age of 18 are NOT eligible for referral through this Ontario Bariatric Program referral system Patients aged 12 17 may be eligible for the SickKids Team Obesity Management Program STOMP and patients aged 6 months to 5 years can be referred to the STOMP Early Years Program For more information on both programs and referral information please visit http www sickkids ca STOMPy index html End Referral Go Back and Edit Referral Duplicate Referrals Before moving past the firs
15. al Program at St Joseph s Healthcare Hamilton SJHH Bariatric Referral Form Your patient is eligible for the Pilot Metabolic Surgical Program offered at St Joseph s Healthcare Hamilton Refer my patient to the Pilot Metabolic Surgical Program at SJHH Cancel Save and Exit Some patients who do not meet the eligibility requirements for the Surgical Program may be eligible for the Pilot Metabolic Surgical Program offered only at St Joseph s Healthcare Hamilton SJHH This program offers bariatric surgery for patients with a BMI between 28 v kg m and 35 kg m who also have complicated type 2 diabetes mellitus Current evidence suggests that when compared with non surgical treatments bariatric surgery for non morbidly obese patients who also have complicated type 2 diabetes is associated with greater weight loss and better intermediate glucose outcomes The Pilot Metabolic Surgical Program at St Joseph s Healthcare Hamilton SJHH aims to confirm the evidence for and analyse the long term results of diabetes resolution and weight loss post procedure for these patients with the ultimate goal of providing improved and expanded services for this population Patients who have met the referral criteria will be assessed at St Joseph s Healthcare Hamilton for Bariatric Surgery Post surgical follow up is routinely scheduled for a period of 5 years Patients across the Province of Ontario can be referred to this program
16. and Type of healthcare coverage The list of filters is below the list of sorting options to the right hand side of the My Referrals page At any time you can revert back to the default view setting by hitting the Reset button which is below the list of patient filters Filtering by Patient Status When you filter by patient status you will be able to locate patients who are within specific stages of the bariatric treatment process Filters Status O Assessment O Discharged O Follow up O incomplete O On Hold O Post op O Pre op O Scheduled O Submitted O Treatment Status Definitions Statuses help to identify at which stage in the bariatric treatment process a patient is When key dates in the patient s treatment care path pass that patient s referral status also changes Some statuses are only for the Surgical Program others for the Medical Program However certain statuses are common to both programs Referral statuses and patient statuses Referral Statuses STATUS TRIGGERED BY Referral has been started and saved but has Incomplete not been submitted Submitted Referral has been successfully submitted lL Orientation has been booked offered date Scheduled has been scheduled Surgical Program Statuses STATUS TRIGGERED BY Includes all pre op visits Initial Referral changes status after orientation assessment final clinical date attended has passed assessm
17. cation Active Physician Delegate Actions v Actions Active Physician Actions Active Physician Displaying 3 of 3 Adding a User Account To add a Centre User a Centre Manager will select the Add User option at the top right hand corner of the users table Status Username Role Location Active Physician Delegate Actions v This will direct you to a web form that requests the following user information e First name e Last name and e Email address Add Account Title First Name Last Name Email J hereby certify that the information above is true and accurate J authorize this user to view and submit referrals under my OHIP Billing number Once you have entered in this information select Add User You will be asked to confirm that you want to create the account Confirmation Are you sure you want to create an account B The newly added user will receive an email from ROME Central with his her username and temporary password Please refer to the section on Logging into the New Online Bariatric Referral System for guidance on how to reset their password and login to the system Remove Security Role Locking a User Account If you would like to remove a user account s access to the new online referral system either due to a change in role a change in job or due to a leave of absence you will select Remove Security Role
18. cheduled ccccccccccccccceeceeceessssssssseeeeccececceeeesaaauaesssssssseeeeeeeececeeeenaaaeaggesnsssss 18 Referral Wi INST CRMC sascasatesedasaan ineateanecninenen bacanahesosiaam harabeacentinesep Ee 18 Rerainan a E 18 Referral Discharged scccccccssssssssessssessesesssscsscscsussesucsesuescsusaesusaesusaesusaesusatsusatsusatseatsneaeeess 19 Submit a Referral ccscsscscsscsccscsccscsccscsccscsscscsscscssoscssees 19 OS O W earair EE E aaiieitapa oasis a netesn E E EA 20 RETOE WOKS NOG borrerina E 20 The Referral FOr ccccccccccscsccccccscececcsceceaesceseuecsseteaeseeseueseseeneneess 22 Health Card and Date of Birth ce ecceccsccsccscecceccececuscsccscascusescescascetescsceseesensases 22 Body Mass Madex BMI ated cs aascaeagitaceate teases Tin S O 25 PACIOUN Y WE ON era A E E 27 EOF MOSS AEOS pisne E E E heaton uniates 29 lecun a Pro a erna E rer ne eee ren 31 Patient Information for Centre Allocation essssssssssssssssserereeesssssssssrrsseseerrreeesessssssseseses 35 SUD MMII ROTOR Fall ecteccdesatucievnassanstueneacesedetteesasetsciennsdsacanernSecanedntbessaeetisevniabacaneemsecauatetesiouetades 38 My Referrals eocire cite cece cceuscecrencienerevenecusecnsecese ececessencacnseecesvese SS Searching Sorting and Filtering the Referral QUEUE ceec cece eee 39 eye ACH a1 cA ac ou ks cee eee ee ae eee ee 39 SO UE ROOT GUS asec recto cxe egeu areas tow eecsacet E E scene 40 Fii
19. ctitioners and or administrators to view their referral history My Referrals Using the built in tools for searching sorting and filtering you can manage your referral list quickly and efficiently Searching Sorting and Filtering the Referral Queue In order to better manage your referral queue you can search sort and filter referrals Searching Referrals To search across your list of referrals you can enter one of the following parameters into the search box e Health card number e Date of birth and e Patient name Home Referrals Notifications Centres Support v Account v My Referrals Submit New Referral Search Action Status Details Patient Referral Q Acti Submitted This referral has been successfully submitted and the 5296 998 726 XU 007100003 i CNIS E centre has been notified for scheduling No action is Surgical Program Sorting Options ar Sudbury Health Sciences North a Submitted 2015 02 11 p Date v pe ee Incomplete This referral has not been submitted Please complete 7276 663 080 Modified 2015 02 09 the referral form First Name Submitted This referral has been successfully submitted and the 5462 395 830 XU 107100002 Actions Health Card Number centre has been notified for scheduling No action is Medical Program required Sudbury Health Sciences North TE Submitted 2015 02 04 f Program Type Submitted This referral has been successful
20. d Orientation Scheduled Hamilton Referral 2015 02 11 002100006 This referral has been discharged by St Joseph s Healthcare Hamilton on 2015 02 11 for the following reason Substance and or alcohol abuse Pilot Metabolic Surgical Program St Joseph s Healthcare Hamilton 2015 01 30 002100013 The patient information has been updated by St Joseph s Healthcare Hamilton on 2015 01 Surgical Program St Joseph s Healthcare Hamilton 2015 01 30 003100001 The patient information has been updated by Humber River Regional Hospital on 2015 01 Surgical Program Humber River Regional Hospital 2015 01 19 002100009 This referral has been scheduled for orientation on 2015 02 05 at St Joseph s Healthcare Pilot Metabolic Surgical Program St Joseph s Healthcare Hamilton 2015 01 15 002100014 This referral has been scheduled for orientation on 2015 01 20 at St Joseph s Healthcare Pilot Metabolic Surgical Program St Joseph s Healthcare Hamilton Displaying 5 of 9 Only the latest records appear on the main landing page and the user must click View All to see the rest of them PLEASE NOTE You can also navigate to your complete notifications list by selecting the Notifications option on the left hand side of the top navigation ribbon ONTARIO Bariatric Network Home Referrals Notifications entres New Referral Enables authenticated doctors nurses other healthcare practitioners and or administ
21. d and change your password on first login Regards PHRI Project Office Once the email is received return to https referrals ontariobariatricnetwork ca Enter your username and temporary password and select Sign In ONTARIO Bariatric Network Sign in to continue to the Referral Portal Username Email Username Email Password a Password The system will display a message that your password has expired select Ok Bariatric Referral Error Password is expired Enter your old temporary password and new password and select Change Password ONTARIO Bariatric Network Your password has expired please create a new one User Name i_loveys Old Password PLEASE NOTE Passwords should have a minimum of 8 characters and contain a mix of character types lower case upper case numbers and or special characters such as S Your Physician dashboard will be displayed upon successful sign in Registering as a Non Physician User Physician Delegate Please use the following instructions only if you do not have an OHIP Billing Number e g Nurse practitioner medical office administrator or assistant or other Physician delegate user accounts enables authorized non physician users to view and submit referrals on behalf of a physician under his her OHIP billing number Navigate to https referrals onta
22. d treatment However your patient may be eligible for referral to the Medical Program Please continue with the referral process if this is a desired option Save and Exit At any time during the referral process you have the option to save the in progress referral exit the referral system and then return to that referral at a later date Showing 2 of 2 referrals that require your action Referrals Action Status Details Patient Referral Edit Incomplete This referral has not been submitted Please complete the No OHIP Number Surgical Program referral form St Joseph s Healthcare Hamilton Modified 2015 03 17 The referral can be accessed again either via the Action Items table on the main landing page of the physician dashboard see above or via My Referrals see below My Referrals Submit New Referral Search Action Status Details Patient Referral Q Acti Incomplete This referral has not been submitted Please No OHIP Number Surgical Program ions i a Sorting Options complete the referral form St Joseph s Healthcare Hamilton Edit Modified 2015 03 17 no entre Delete d This referral has been successfully submitted and No OHIP Number 002100043 es the centre has been notified for scheduling No Surgical Program Date action is required i View Referral q St Joseph s Healthcare Hamilton FirstName Referral History Submitted 2015 03 17 T Health Card Number e Incomnlete This r
23. e RCMP and has health coverage under the Federal Public ime a G MOHLTC O Isa Status Indian and has health coverage under Health Canada s First Nation and Inuit Health Program O Isa refugee and has health coverage under the Interim Federal Health Program IFHP He t i Further bariatric surgery Revision or conversion of a previous bariatric surgery O O Z O Z O O Has other health coverage through another program not listed above please specify i Adiu a Please specify TO CALCULATE BODY MASS INDEX BMI O v Follow up care for surgical complications and or medical issues T Does your patient currently have a problem with alcohol and or drags EN CAASA o a iane er e Bee E Senha Pres ot SE ees e aaa a Feber for this as o My patient is aware that he she will need to assume the cost of travel and accommodation arrangements and radiation F our paties 6 months PATIENT CONTACT INFORMATION First Name Last Family Name Address ON Ontario Province Postal Primary Number Ext Secondary Phone Number Typet Home O Mobile O Work Tye O0 O Work PLEASE NOTE If you have not already registered to submit referrals via the online referral portal the following information is required for registration The following sections fields are required REFERRING HEALTHCARE PROVIDER INFORMATION Titie 0 D O Mr O Mrs O Prof O Ms O Miss OHIP Billing Number 6 digits
24. e to access the most up to date information when trying to contact the patient To edit your patient s contact information go to My Referrals and select the referral that you want to update At the top of this list is the option to Edit Contact Information You will be taken to the following web form where you can make any changes to the patient s contact information Edit Contact Details First Name Last Name Address City Postal Code Phone Number Type Choose a Phone v Secondary Phone Number Type Secondary Phone Number Choose a Phone v Email View Referral From the Referral Actions drop down menu you can also view the submitted referral in its entirety with the option to save the file as a PDF or to print it out for inclusion in a paper chart Viewing the entire referral enables you to see all the pertinent information in a single easy 45 to navigate form including e Referral Information Referral ID number bariatric program type bariatric centre assignment and date referral submitted e Patient Information Patient name and contact information health card number date of birth sex BMI EOSS score referral alerts warning messages and additional comments e Physician Information OHIP billing number physician name and contact information e Answers to all the referral questions Where a question wasn t answered an N A will appear Referral Information
25. ecting the Edit option from the User Action Items drop down menu to the left of each user name on your list of users Action Status Username Name Actions zat Active Role Location Email Physician Displaying 1 of 1 Once Profile is selected from the top menu bar you will navigate to the main profile page From here you can e View your profile information including the date that your password will expire Edit your contact details and e Reset your password ONTARIO Bariatric Network Home Referrals Notifications Centres Profile User Name i_physict Password Expiry 2015 06 17 Edit Contact Details Title First Name v Test Last Name Physician Email kristenavery1986 gmail com Edit Clinic Details Office Clinic Name Test Clinic Primary Practice Address Test Address City Test City Province Ontario Postal Code L9C1A1 Office Clinic Phone Ext Secondary Phone optional Ext Fax Secondary Fax optional Save Changes Cancel Reset Password Functions for Physician Users Only There are specific account management functions that only physician users can utilize These include e Adding a user account e Locking deactivating a user s account As described above if you select Users on the drop down menu you will be navigated to a list of all user accounts at your centre Action Status Username Role Lo
26. eferral Error Password is expired Enter your old temporary password and new password and select Change Password ONTARIO Bariatric Network Your password has expired please create a new one User Name Zs i_loveys Old Password PLEASE NOTE Passwords should have a minimum of 8 characters and contain a mix of character types lower case upper case numbers and or special characters such as S Your Physician dashboard will be displayed upon successful sign in Logging In to the New Online Bariatric Referral System Once you have been given your login credentials and password you will be able to login to the new online bariatric referral system at https referrals ontariobariatricnetwork ca You can use your username email address or OHIP billing number to do so ONTARIO Bariatric Network Sign in to continue to the Referral Portal Username Email Billing Username Email Billing Password AQ Password Need help Forgot password Need an account Register here Logging in as a Physician Delegate For users working as a delegate for multiple physicians you will be asked to select a physician to work on behalf of each time that user logs into the new online referral system Bariatric Referral Please select a physician to work on behalf of in the top right corner of your screen or The delegate user can s
27. eferral has not heen submitted Please TITEFEVNBN Medical Pranram To reopen the referral and continue where you left off click the option to Edit Selecting a Program At the end of the referral process you will select the option to check eligibility which will be assessed based on the information from the referral questions In certain cases your patient will be deemed ineligible for all Ontario Bariatric Programs currently offered Bariatric Referral Form Your patient is ineligible for the Ontario Bariatric Programs currently offered Your patient does not currently meet the eligibility criteria requirements for the Ontario Bariatric Programs funded by the Ministry of Health and Long Term Care MOHLTC Please seek programs within your local community Cancel Save and Exit In this case physicians and other referring healthcare providers are encouraged to seek out appropriate treatment programs within the community to help treat your patient s obesity If your patient meets the eligibility criteria and requirements for one or more of the three Ontario Bariatric Programs offered you will be asked to select which program you would like your patient to be referred to These programs include e Bariatric Surgical Program e Bariatric Medical Program e Pilot Metabolic Surgical Program at St Joseph s Healthcare Hamilton For an overview of eligibility rules for each program please refer to the Ontario
28. elect the physician they wish to work on behalf of by selecting that physician from the drop down menu on the top left hand corner of the physician dashboard ONTARIO Welcome Bariatric Network Working on behalf of Choose a Physician Home Referrals Notifications Centres Support Account New Referral My Referrals Enables authenticated doctors nurses other healthcare practitioners and or Enables authenticated doctors nurses other healthcare practitioners and or administrators to fill out and submit referral forms for their patients administrators to view their referral history Submit Referral My Referrals PLEASE NOTE Physician Delegates can also select which physician they are working on behalf of by navigating to the Account drop down menu and selecting Users ONTARIO rome Bariatric Network Home Referrals Notifications Centres Support Account Users Profile New Referral My Referrals Enables authenticated doctors nurses other healthcare practitioners and or Enables authenticated doctors nurses other healthcare practi Logout administrators to fill out and submit referral forms for their patients administrators to view their referral history Submit Referral My Referrals This will take you to a table that lists all the physicians that the Physician Delegate is authorized to view and submit referrals for From the Action Items drop down menu to the left of a physician na
29. ent pre op and treatment decision dates Bosto Referral change status after past official Includes all post op follow up i surgery date has passed visit dates up to 5 years Medical Program Statuses STATUS TRIGGERED BY Pre op Includes all pre treatment visits Referral changes status after orientation Initial assessment final clinical date attended has passed assessment and treatment decision dates Referral changes status when treatment Treatment commencement date passes Includes all post treatment follow up visit dates up to 2 years Assessment Referral changes status after treatment Follow u P completion date passes Patient Statuses As with the referral statuses above patient statuses are common to all referrals regardless of program stream STATUS DEFINITION NOTES Onhald Referral has been placed on hold due to reason Upon discharge a physician can re refer or submit a subsequent referral for the patient Referral has been discharged due to reason Discharged Filtering by Bariatric Program When you filter by bariatric program you will be able to see which referrals were referred to each of the three bariatric programs currently offered e Surgical Program 43 j e Medical Program and e Pilot Metabolic Surgical Program at St Joseph s Healthcare Hamilton Program O Medical Program D Pilot Metabolic Surgical Program O Surgical Program Filt
30. ering by Healthcare Coverage Whether your patient has healthcare coverage through the Ontario Health Insurance Program OHIP e g has an Ontario health card number or if your patient has coverage through another recognized provincial federal healthcare funding e g does not have an Ontario health card number Patient O No OHIP O OHIP Referral Actions Drop Down Menu When on the My Referrals page the referring healthcare provider can also access the referral actions drop down menu This is located to the left of each referral Submitted 2015 02 11 Actions a Submitted This referral has been successfully submitted and 5462 395 830 XU 107100002 the centre has been notified for scheduling No Medical Program action is required Sudbury Health Sciences North Edit Contact Info Submitted 2015 02 04 View Referral d This referral has been successfully submitted and 3951 631 773 XU 007100002 Referral History the centre has been notified for scheduling No Surgical Program T action is required Sudbury Health Sciences North Submitted 2015 02 04 From here physicians can e Edit patient contact information e View the referral and e View the referral history Edit Patient Contact Information After a referral has been successfully submitted physicians can only edit or update the patient s contact information All changes occur in real time ensuring the bariatric centre will be abl
31. erral is scheduled for orientation on 2015 01 23 This referral has been successfully submitted and the centre has been notified for scheduling No action is required This referral has been transitioned to pre op This referral has been transitioned to pre op This referral has been transitioned to pre op Patient 7276 663 080 4999 754 601 4970 258 127 GH 8993 335 689 LA No OHIP Number 4565 587 203 ZZ No OHIP Number Submit New Referral Referral Modified 2015 02 09 101100001 Medical Program Guelph General Hospital Submitted 2015 01 14 003100001 Surgical Program Humber River Regional Hospital Submitted 2015 01 14 008100002 Surgical Program Kingston Hotel Dieu Hospital Submitted 2015 01 14 002100014 Pilot Metabolic Surgical Program St Joseph s Healthcare Hamilton Submitted 2015 01 15 002100013 Surgical Program St Joseph s Healthcare Hamilton Submitted 2015 01 15 002100009 Pilot Metabolic Surgical Program St Joseph s Healthcare Hamilton Submitted 2015 01 14 Support Account Search Sorting Options Centre A Date First Name Health Card Number Last Name Program Type Referral Number Status Filters Status O Assessment O Discharged O Follow up O incomplete O On Hold O Postop Filtering Referrals To filter your list of referrals you can select one or multiple filters The available filters include Patient status Bariatric program
32. he patient s referral is transferred between bariatric centres This is meant to keep the physician up to date as to where his her patient is receiving bariatric treatment Mark as Read Referral Transferred 2075 03 25 1027100025 This referral was successfully transferred from Toronto Western Hospital to p st Joseph s Healthcare Hamilton on 2015 03 25 A notification will be sent Medical Program once the referral is scheduled for orientation St Joseph s Healthcare Hamilton Referral On Hold Physicians will be notified when their patients are placed on hold Patient holds indicate that patient is still participating in bariatric treatment but that they are clinically inactive which is indicative of a barrier that prevents the patient from continuing in the program for a specified amount of time Examples of hold reasons include smoking psychiatric issues substance and or alcohol abuse as well as patient or bariatric centre request Centres will place patients on hold for a pre determined amount of time in order to address the issue that is preventing them from moving forward in the bariatric treatment program Mark as Read Referral On Hold 2015 03 25 002100067 This referral has been placed on hold by St Joseph s Healthcare Hamilton on 2015 03 25 for the following reason Substance and or alcohol abuse Surgical Program St Joseph s Healthcare Hamilton For example a centre might place a patient s refer
33. healthcare practitioners and or administrators to fill out and submit referral forms for their patients administrators to view their referral history Submit Referral qm My Referrals If at any time you have any technical issues and or inquiries please contact PHRI at bariatricreferral techsupport phri ca PLEASE NOTE This email is meant to facilitate communication about technical issues and or inquires only Do not send any personal health information via email or other unsecured means Overview Patients who are residents of Ontario and who have healthcare coverage OHIP or other recognized provincial federal funding can be referred to the Ontario Bariatric Programs Eligibility to each program is based on a combination of factors determined by a series of questions about your patient s e Age e Body mass index BMI e Relevant medical history e g obesity related co morbid conditions previous history of bariatric surgery and e Lifestyle choices as well as any health compromising behaviours Referral Worksheet To streamline the process further a referral worksheet is available under the support tab on the top right hand side of the screen ONTARIO aiaia Bariatric Network Home Referrals Notifications Centres Support Account Support Referral Form Workshee New Referral My Referrals Referral Process Enables authenticated doctors nurses other healthcare practitioners and or Enable
34. icated type 2 diabetes mellitus Eligibility Questions The final three pages of the referral form are a series of questions to assess eligibility to one or more of the bariatric programs currently offered Bariatric Referral Form 1 Does your patient currently have a problem with alcohol and or drugs No Yes 2 Does your patient have a recent history of major life threatening cancer within the last 2 years No Yes 2a Is your patient currently undergoing active treatment for this cancer e g chemotherapy radiation O No Yes 3 Does your patient have a history of a major cardiovascular event within the last 6 months No Yes 4 Does your patient currently have a significant psychiatric illness 2 No Yes 4a Is your patient s significant psychiatric illness untreated or inadequately treated No Yes 5 Does your patient currently smoke e g cigarettes cigars cigarillos e cigarettes No Yes 6 Does your patient have coronary heart disease No Yes Cancel Save and Exit These questions will ask about your patient s e Relevant medical history e Current clinical assessment e Lifestyle choices e Health compromising behaviours e g smoking and e Previous history of bariatric surgery Bariatric Referral Form 7 Does your patient have type 2 diabetes mellitus J No Yes 7a Does your patient have complicated type 2 diabetes mellitus No
35. ilable by clicking on the following pop up symbol at the end of this secondary consent which triggers the Northern Health Travel Grant NHTG Program Regarding travel expenses for patients in Northern Ontario You may be eligible for the Northern Health Travel Grant NHTG Program For more information please call 1 800 461 4006 or visit http www health gov on ca en public publications ohip northern aspx Submit Referral Once complete you will select the button at the bottom of the page This will direct you to the following confirmation page Bariatric Referral Form You have successfully submitted the referral Referral ID 002100043 Bariatric Program Type Surgical Program Centre Assignment St Joseph s Healthcare Hamilton Date Referral Submitted yyyy mm dd 2015 03 17 Patient Name Health Card No OHIP Number Date of Birth yyyy mm dd 1982 01 01 Save Print Referral View Referral My Referrals Exit From here you have the option to e Save or print the entire referral e Save or print the referral confirmation page e To view the entire referral or e To navigate to My Referrals which is a list of all the referring healthcare providers referrals My Referrals The My Referrals button on the main physician dashboard landing page will navigate you to a page where all of your referrals are listed The default sort of this list is the date of submission from newe
36. located beneath the 49 filter options Filtering User Accounts To filter your list of referrals you can select one or multiple filters The available filters include e Status active or locked and e Type of role The list of filters is below the list of sorting options to the right hand side of the referral queue page Filters Status O Active O Locked Role O Physician Delegate Filtering by Status When you filter by status you are able to view only active users or only locked inactive users associated with your account Filtering by Role When you filter by role you are able to view only Physician Delegate user accounts which shows you which users are authorized to work on behalf of the physician account Account Profile To navigate to your Profile select this option under the Account drop down menu at the top right hand side of the top menu bar ONTARIO Bariatric Network Home Referrals Notifications Centres New Referral Enables authenticated doctors nurses other healthcare practitioners and or administrators to fill out and submit referral forms for their patients Submit Referral Welcome Support Account v Users My Referrals ie Enables authenticated doctors nurses other healthcare practi Logout administrators to view their referral history My Referrals PLEASE NOTE You can also access your Profile by sel
37. ly submitted and the 3951 631 773 XU 007100002 Actions v i a centre has been notified for scheduling No action is Surgical Program Sudbury Health Sciences North Submitted 2015 02 04 Referral Number required Status Sorting Referrals To sort your list of referrals select one of the sorting options to the left of My Referrals The list of sorting options is below the search box which is on the left hand side of your My Referrals screen You can sort by e Centre Assignment A Z Z A e Date referral submitted oldest newest newest oldest e Patient first name A Z Z A e Patient last name A Z Z A e Health card number ascending descending e Program type A Z Z A e Referral number ascending descending and e Referral status newest oldest oldest newest Upon selection the list of referrals will reorder itself based on the sorting option selected In the example below this physician s referral list was sorted by centre assignment A Z Home Referrals My Referrals Action Status Actions Incomplete Actions v Submitted Actions Scheduled Actions Submitted Actions Pre op Actions Pre op Actions Pre op Notifications Centres Details This referral has not been submitted Please complete the referral form This referral has been successfully submitted and the centre has been notified for scheduling No action is required This ref
38. me you can also select Work on Behalf Of Action Status Username Name Role Location Email Actions Active Physician Deleaate Actions Active Physician Edit Physician 7 Work on behalf of Displaying 3 of 3 Forgot Password If you have forgotten your password you will enter your user name and click on the Forgot Password link located under the Need Help heading You will be asked to confirm that you want to reset your password Confirm Password Reset Are you sure you want to reset your password Once you click Yes you will receive another pop up informs you that you have received an email with instructions on how to reset your password Password Reset Password reset instructions sent via email Please check your email Ok PLEASE NOTE Passwords should have a minimum of 8 characters and contain a mix of character types lower case upper case numbers and or special characters such as S Physician Dashboard The main landing page for physician users is the physician dashboard Here the most commonly used features and functions that a physician will use are displayed for easy access These include e Submitting a new referral e Action items e Notifications and e My Referrals ONTARIO Bariatric Network Home Referrals Notifications Centres New Referral Enables authenticated doctors nurses othe
39. nt programs currently offered in Ontario The referral form is comprised of five separate pages of information Health card number and date of birth body mass index BMI and eligibility questions PLEASE NOTE The 6 symbol indicates that there is additional information available The information pages open up in a new tab so you do not lose your place within the referral process For example if you click on the symbol next to the title Bariatric Referral Form Bariatric Referral Form A page with a description of the bariatric referral process will open in a new browser tab The Referral Process The Bariatric Referral Web Portal is a centralized referral process that will enable doctors nurses other healthcare practitioners and or administrators to enter standard referral data for their patients into a database Once referred those patients who have met the referral criterion are assessed at a Bariatric Centre of Excellence BCoE or a Regional Assessment and Treatment Centre RATC which are assigned based on patients postal codes ensuring that patients receive bariatric treatment as close to home as possible Once the referral is submitted eligible patients will be contacted by the Bariatric Centre and invited to attend an orientation session where each will be given a comprehensive screening and assessment to ensure the appropriateness of their selected Bariatric Program For eligible patien
40. ou to input your patient s height and weight You have the option to submit this information using metric or imperial units of measurement or a combination of the two In the case of using a combination of the two enter the first measurement using the metric unit of measurement Once the first is entered switch over to imperial and enter the second Bariatric Referral Form BMI Unit of Measurement J Metric Imperial Height 163 cm 5 ft 4 in Weight 113 kg 250 Ib Your patient s body mass index BMI is 43 Cancel Save and Exit When both height and weight are inputted into the system your patient s body mass index BMI will be automatically calculated by the system BMI thresholds for the programs are as follows Surgical Program To be eligible for the Surgical Program your patient must either have a BMI of 235 as well as the existence of at least one obesity related co morbid condition or have a BMI of 240 without a co morbid condition Medical Program To be eligible for the Medical Program your patient must either have a BMI of 230 as well as the existence of at least one obesity related co morbid condition or have a BMI of 235 without a co morbid condition Pilot Metabolic Surgical Program at St Joseph s Healthcare Hamilton To be eligible for the Pilot Metabolic Surgical Program at St Joseph s Healthcare Hamilton your patient must have a BMI 228 and lt 35 in addition to compl
41. r healthcare practitioners and or administrators to fill out and submit referral forms for their patients Submit Referral Welcome Support Account My Referrals Enables authenticated doctors nurses other healthcare practitioners and or administrators to view their referral history My Referrals Action Items Below this you will find the 5 most recent tasks requiring action on the part of the referring healthcare provider with an option to View All The most frequent action item listed for physician users will be reminders about referrals that have been saved as incomplete Showing 1 of 1 referrals that require your action Referrals Action Status Details Patient Referral Edit Incomplete This referral has not been submitted Please complete the referralform 7276 663 080 Moadified 92N15_99 99 Displaying 1 of 1 Only the latest records appear on the main landing page and the user must click View All to see the rest of them Notifications In addition to action items the 5 most recent notifications for changes in the referring provider s patient s referral status with an option to View All Showing 5 of 9 notifications for your review Notifications Action Notification Mark as Read Referral Discharged Mark as Read Patient Information Updated 30 Mark as Read Patient Information Updated 30 Mark as Read Orientation Scheduled Hamilton Mark as Rea
42. r patient s medical history physical examination and the results of standard diagnostic tests NO signs of obesity related factors NO physical symptoms NO psychological symptoms NO functional limitations Patient has obesity related subclinical factors OR MILD physical symptoms patient currently not requiring medical treatment for comorbidities OR MILD obesity related psychology and or mild impairment of well being Patient has an ESTABLISHED obesity related comorbidity requiring medical intervention OR MODERATE obesity related psychological symptoms OR MODERATE functional limitations in daily activities s Patient has significant obesity related end organ damage OR SIGNIFICANT obesity related psychological symptoms OR SIGNIFICANT functional limitations OR e SIGNIFICANT impairment of well being e SEVERE potential end stage from obesity related chronic disease OR SEVERE disabling psychological symptoms OR SEVERE functional limitations Patient Allocation After assigning an EOSS score for your patient you will be asked to enter your patient s contact information into the system The required fields include e Fullname e Address including city and postal code and e Telephone number and type Optional fields include e A secondary telephone number and type for your patient e Your patient s email address and e Any additional comments that you migh
43. ral on hold if they are smoking and in the Surgical Program In this case the patient becomes inactive in the bariatric treatment program until they are able to stop smoking Once this occurs the hold is be released and the patient is free to continue in the program Referral Discharged Finally physicians will also receive a notification informing them that their patient has been discharged out of the bariatric treatment program because they are not clinically fit to continue within it The reasons why a patient s referral might be discharged are similar to reasons why they have been placed on hold and include smoking psychiatric issues substance and or alcohol abuse as well as patient or centre request Mark as Read Referral Discharged 2015 03 25 002100062 This referral has been discharged by St Joseph s Healthcare Hamilton on 2015 03 25 for the following reason Substance and or alcohol abuse Surgical Program St Joseph s Healthcare Hamilton Upon discharge patients are able to be re referred to a bariatric program Submit a Referral To submit a referral for your patient please click on the link submit referra set of instructions provided below and follow the ONTARIO Bariatric Network Home Referrals Notifications Centres Support Account v New Referral My Referrals Enables authenticated doctors nurses other healthcare practitioners and or Enables authenticated doctors nurses other
44. rators to fill out and submit referral forms for their patients Submit Referral Welcome Support Account My Referrals Enables authenticated doctors nurses other healthcare practitioners and or administrators to view their referral history My Referrals Examples of notifications include messages to the physician regarding his her patient s change in status at the centre level and include Patient Information Updated Physicians will receive a notification when the patient s contact information has been updated Similarly when physicians update their patient s contact information the bariatric centre to which that patient was referred will also receive a notification Mark as Read Patient Information Updated 2015 03 25 002100063 The patient information has been updated by St Joseph s Healthcare Hamilton on 2015 03 25 Pilot Metabolic Surgical Program St Joseph s Healthcare Hamilton Referral Scheduled When the physician receives a Referral Scheduled notification this is to let him her know that his her patient has been successfully scheduled to attend an orientation on a specific date Mark as Read Referral Scheduled 2015 03 25 102100016 This referral has been scheduled for onentation on 2015 03 25 at St Joseph s Healthcare Hamilton Medical Program St Joseph s Healthcare Hamilton Referral Transferred A physician will also receive a notification when t
45. riobariatricnetwork ca and select Register here from the Bariatric Referral landing page Need an account Register here Select your role from the I am a drop down list Registration lam a Choose a Specialty v Choose a Specialty Primary Care Physician Medical Internist Family Physician Specialist please specify Nurse Practitioner Other please specify Medical Office Assistant Enter your title optional first name last name and email Registration am a Medical Office Assistant T Title First Name Last Name Email Complete the Physician Details section of the registration form and select Register Physician Details OHIP Billing Title Physician s First Name F Physician s Last Name Office Clinic Name Primary Practice Address City Province Ontario Postal Code Office Clinic Phone Ext Secondary Phone optional Ext Fax Secondary Fax optional Email O hereby certify that the information above is true and accurate O On behalf of the referring physician agree to work in partnership with the bariatric clinic to provide my patient with the necessary medical care and support throughout the course of his her bariatric treatment Add another Physician PLEASE NOTE You can add multiple Physicians by selecting Add another Physician at the bottom of the page Select
46. s nurses other healthcare practitioners and or administrators to fill out and submit referral forms for their patients administrators to view their referral history Submit Referral My Referrals If this referral was previously submitted by your office and you wish to link it to your new referral portal account you will be directed to fax PHRI directly at 905 577 8258 In the body of the fax please provide enough information for PHRI to determine that you are authorized as referring healthcare provider to view this referral PHRI will only link referrals to physician accounts were definitive linkages can be proven Re Referrals or Subsequent Referrals Physicians can re refer or submit a subsequent referral for patients whose previous referrals are inactive e g have been discharged out of the system When Physician enters a health card number and date of birth that matches a discharged referral the following message is displayed Warning The OHIP number and date of birth entered match an inactive referral submitted on 2015 03 05 to St Joseph s Healthcare Hamilton Please continue if you wish to re refer this patient End Referral T j When Physician selects continue and submits the re referral if the same Physician as first discharged referral they will see both discharged and submitted referrals in their list When Physician selects continue and submits the re referral
47. s authenticated doctors nurses d FAQs id or administrators to fill out and submit referral forms for their patients administrators to view their referral histot Contact Us Submit Referral My Referrals This referral worksheet is to help physicians and their staff to submit a referral using the new bariatric online referral portal By utilizing this worksheet physicians are able to fill in the clinical information and then hand over the referral for entry into the online system by one of their employees at the clinic ONTARIO ONTARIO BARIATRIC PROGRAMS Bariatric Network REFERRAL WORKSHEET PLEASE NOTE All referrals to Ontario Bariatric Programs are to be submitted via the online referral webportal This worksheet has been provided for reference purposes only and will help you and your office to submit a referral using the online referral webportal As such it is not a valid referral form The following sections fields are required PATIENT INFORMATION FOR REFERRAL Date of Birth YYYY MM DD MoethanSyeasago OOOO D Lessthan 5yearsago S U U U O Ontario Health Card Number __ Cs ersiom Code O 1 dontknw S S O My patient is a resident of Ontario but does not have an Ontario Health Card My patient select one of the Following a emcee a ee Tale ale Isa member of the Canadian Armed Forces CAF and hes health coverage under the Miltary Hesith Care Pian a Is a member ofthe Royal Canadian Mounted Polic
48. s bariatric surgery O Adjustment or repair to an existing adjustable gastric band Further bariatric surgery after previous removal of an adjustable gastric band O Management of weight regain Follow up care for surgical complications and or medical issues oum Cancel Save and Exit Error Messages There are two types of error messages in the new online bariatric referral system ineligible messages and warning messages Ineligible Messages The first is an ineligibility message which signals that your patient is ineligible to all bariatric programs currently offered When an ineligibility message is triggered you have two options to go back and edit the referral if you ve mistakenly entered an incorrect answer or to end the referral process completely Ineligible Your patient is currently ineligible for all Ontario Bariatric Programs Please re refer after your patient has been adequately treated for alcohol and or drug dependency for more than 6 months End Referral Go Back and Edit Referral After you click away from the pop up with the warning message this message is displayed on screen for further reference 1 Does your patient currently have a problem with alcohol and or drugs J No Yes Your patient is currently ineligible for all Ontario Bariatric Programs Please re refer after your patient has been adequately treated for alcohol and or drug dependency for more than 6 months
49. s new system is a webportal that streamlines the process for referral and enables referring healthcare providers the ability to refer patients to multiple bariatric programs each with its own referral and eligibility criteria using one easy to use referral form The ultimate goal of this new system is to e Improve the care of the obese patient e Improve access to care and reduce wait times and e Increase the effectiveness of healthcare dollars spent Benefits of the New Referral System for Physicians and Other Referring Healthcare Providers The new user friendly interface offers the following features for referring healthcare providers e Referrals can be started saved and returned to at a later time e Physician administrative staff can be granted access to enter referrals and track patient progress e Eligibility will be determined immediately by the system e Physicians will know which bariatric centre their patient has been allocated e Referrals will be immediately forwarded to the assigned bariatric centre upon submission e The submitted referral form can be printed or saved as a PDF for your records e Physicians can now check on your patients status and track their treatment progression e Physicians are able to view a list of their previous referrals Technical Specifications The new online bariatric referral system works best using the following internet browsers e Google Chrome e Internet Explorer
50. se to home as possible Eligible patients will be contacted by the Bariatric Centre and invited to attend an orientation session followed by a comprehensive screening and assessment process to ensure the appropriateness of their selected Bariatric Program For eligible patients intensive education and nutritional counselling is provided as well as routine post program follow up This section gives an overview of all of the functions that referring healthcare providers will use when logging into the new online bariatric referral system The Purpose of a New Online Bariatric Referral System As of April 1 2015 the referral process will be revised from a fax based process to an online system The Ontario Bariatric program has evolved to now include 3 programs with unique criteria The centralized fax based referral process which has been in place since 2009 was unable to address the recent evolution of the program To meet the needs of the system a new online bariatric referral system was developed and deployed which replaces the old fax based system The new online bariatric referral system enables physicians to directly refer patients who are residents of Ontario and who have healthcare overage OHIP or another recognized provincial federal health coverage to one of three bariatric programs e Surgical Program e Medical Program and e Pilot Metabolic Surgical Program at St Joseph s Healthcare Hamilton SJHH Thi
51. ssignment depends on patient postal code and Centre volume Medical Program Bariatric Referral Form Your patient is eligible for the Bariatric Medical Program Refer my patient to the Bariatric Medical Program Back Cancel Save and Exit Of the 9 bariatric treatment centres in Ontario 8 offer a non surgical treatment options and is classified as the Medical Program This program provides comprehensive services led by a multidisciplinary team for obese adults focusing on the identification and treatment of obesity related health conditions safe weight management and healthy lifestyle changes Patients attend an intake or orientation session followed by a medical appointment and baseline investigation The program consists of different streams including behavioural modification with or without partial or total meal replacement Duration of follow up varies depending on the treatment plan to a period of up to 2 years The streams in the medical program offer standardized treatments that meet the patient s needs e Total and partial meal replacement plans e Lifestyle program behavioural therapy e One to one program and e Anti obesity medication Patients who have met the referral criteria are assessed at their assigned Bariatric Centre of 33 Excellence BCoE or Regional Assessment and Treatment Centre RATC Centre assignment depends on patient postal code and Centre volume Pilot Metabolic Surgic
52. st to oldest As detailed in the section below users will be able to search across this list resort the list and filter results Physician and other healthcare provider users can also use this list to track your patient s progress through the bariatric program as the referral system is linked to the bariatric centre s case management system As a result when your patient s status changes e g scheduled for orientation you will receive updates in real time ONTARIO Bariatric Network Home Referrals Notifications Centres New Referral Enables authenticated doctors nurses other healthcare practitioners and or administrators to fill out and submit referral forms for their patients Submit Referral Welcome Support Account My Referrals Enables authenticated doctors nurses other healthcare practitioners and or administrators to view their referral history My Referrals r PLEASE NOTE You can also navigate to your referrals list by selecting the Referrals option on the left hand side of the top navigation ribbon ONTARIO Bariatric Network Home Referrals Notifications Centres New Referral Enables authenticated doctors nurses other healthcare practitioners and or administrators to fill out and submit referral forms for their patients Submit Referral Welcome Support Account v My Referrals Enables authenticated doctors nurses other healthcare pra
53. t have The additional comments field is for short messages about your patient that will be forwarded as information only to the bariatric centre where your patient is assigned Based on your patient s postal code he she will be allocated to the closest bariatric treatment centre to him her This is to ensure that your patient will receive bariatric treatment as close to home as possible Currently there are 9 bariatric treatment centres and 3 surgical only sites in the Province of Ontario For a description of the different types of bariatric treatment centres please refer to the Ontario Bariatric Network s website at http www ontariobariatricnetwork ca our centres Patient Consent Once you have entered in all of your patient s contact information and your patient has been allocated to a bariatric centre based on your patient s postal code you will be asked to check a box that affirms that your patient consents to be referred to the selected bariatric program My patient consents to be referred to the EEEL T Ke B ee E iii PLEASE NOTE Patients who are being referred to the Pilot Metabolic Surgical Program at St Joseph s Healthcare Hamilton SJHH must also consent to the following My patient is aware that he she will need to assume the cost of travel and accommodation arrangements and expenses Information on additional funding programs for patients from Northern Ontario is ava
54. t page of the referral form the system will check for duplicate referrals using both the patient s health card number and date of birth If your patient has already has an active referral in the system you will be alerted to this by pop up Ineligible The OHIP number and date of birth entered match an active referral submitted on 2015 03 05 to St Joseph s Healthcare Hamilton Please contact this Bariatric Centre directly if you have any clinical questions about this patient or if you have questions about this patient s clinical status If this is your patient and you are authorized to view this referral please fax your request to PHRI at 905 577 8258 Do not send any personal health information via email or other unsecured means If you have any technical issues and or inquiries please contact PHRI at bariatricreferral techsupport phri ca End Referral Go Back and Edit Referral If you have any clinical questions about the patient or questions about the patient s clinical status you will be directed to contact the bariatric centre to which this referral was submitted Contact information for centres can be found under the Centres tab on the top banner to the left hand side of the page ONTARIO Welcome Bariatric Network Home Referrals Notifications Centres as Support Account New Referral My Referrals Enables authenticated doctors nurses other healthcare practitioners and or Enables authenticated doctor
55. ternng Referrals asninn TA T NA 41 Referral Actions Drop Down Me Nnu c ccsccccceccessasccsccessuscaseoessursas 44 Edit Patient Contact Information cccccccccccccceeceseesssssssseseeeececeeceeeeeeseaauaaesasseeeeeeeeeeess 45 VOW al MM css ate etter E E 45 PETS all FSCO noe pana asatners eect 47 ACCOUNT Management ccsccsccscsscsccsccsccsccsccsccsccscesccscess GD Searching Sorting and Filtering User ACCOUNTS ccceceeseeeseeseeees 48 Searching User ACCOUN S eseina 49 OPNE USOT AC COUN eai E E E E 49 Filtering User ACCOUNTS ersieinreiis innerer E E T 50 ACCOUNT POTG mergen E E E E E E EE 50 Functions for Physician Users Only ccccecceecceseeseesseeseeseesseeseesees 52 Addmg a User ACCOUNT tcc tec es sacra sea E AS 53 Remove Security Role Locking a User ACCOUNL ccccccccccccccccccceeeeeeeeeeeeeeeeeeeeeeeeeeeeees 54 Physician User s Guide to the New Online Bariatric Referral System Introduction The new online bariatric referral system is a centralized referral process that will enable doctors nurse practitioners other healthcare practitioners and or administrators to enter a set of standardized referral data for their patients into one easy to use system Eligible patients will be allocated to a Bariatric Centre of Excellence BCoE or a Regional Assessment and Treatment Centre RATC based on their postal code ensuring that patients receive bariatric treatment as clo
56. ts intensive education and nutritional counselling is provided and post program follow up is routinely scheduled for a period determined by the type of Bariatric Program the patient receives The Bariatric Referral Web Portal will replace the current fax based referral process and will streamline the referral process with the ultimate goals of improving care of the obese patient reducing wait times and increasing the effectiveness of healthcare dollars spent The Bariatric Referral Web Portal is part of the Bariatric Registry which is a centralized observational multi centre database registry designed to collect standardized information on patients undergoing bariatric treatments at clinical BCoEs and RATCs across Ontario including patient characteristics surgical procedures non surgical treatments medical and psychosocial outcomes and economic factors The data collected will also help to identify new risks and assist in developing strategies to address them inform decision makers ensure patients safety and identify practices and health services areas that require optimization and improvement This information will be used to achieve the goals of increasing the effectiveness and efficiency of care for obese patients helping to reduce costs associated with the duplication of treatment as well as the need to send patients out of country for their bariatric care Ultimately this data and information will lead to the development of specific Can
57. ubmitted yyyy mm da 2015 03 06 Comments Transfer History Type Date From To Back View Referral gt View Past Referral Past Referral History 4 Tracking Patient Progress Under My Referrals you can also track your patient s progress utilizing statuses Statuses help to identify at which stage in the bariatric treatment process a patient is When key dates in the patient s treatment care path pass that patient s referral status also changes For a list of referral statuses and descriptions that referrals in the new online bariatric referral system can take on please refer to the section on filtering your referral queue by status Account Management To access all account management functions please navigate to the Account drop down menu on the top right hand side of your screen and select Users ONTARIO ali Bariatric Network Home Referrals Notifications Centres Support Account Users Profile New Referral My Referrals Enables authenticated doctors nurses other healthcare practitioners and or Enables authenticated doctors nurses other healthcare practi Logout administrators to fill out and submit referral forms for their patients administrators to view their referral history Submit Referral My Referrals This will take you to a list of all users who are associated with your account This includes Physician Delegates nurse practitioners administrative and
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