GROUP VISIT TOOLKIT

Improve the health of your patientswith meaningful information

• Easy to implement

• Cost-effective

• Time-efficient

• Insurance-friendly

FOR ADDITIONAL GROUP VISIT RESOURCES, VISIT LifestyleMatrix.com

Healthy Weightfor Life

Your patients want to change…now you have the tools

• Overweight/Obese• Prediabetes/Type 2 Diabetes• Hypertension• Hyperlipidemia

• Coronary Heart Disease• Stroke• Liver and Gallbladder Disease• Osteoarthritis

• Gynecological problems• Cancer • Sleep Apnea and breathing problems

This essential toolkit educates patients on obstacles to achieving a healthy weight and maintaining it for life. By exploring in�ammation and detoxi�cation, patients will recognize patterns and long-term e�ects of unhealthy behaviors. Understanding the pitfalls of appetite suppressants and excessive calorie restriction will help patients embrace lifestyle choices that create lifelong, optimal body composition and chronic disease prevention. Use for patients with these issues:

THIS GROUP VISIT TOOLKIT INCLUDES:

© Living Wellness, LLC 2015. All rights reserved.

Visit Forms:Patient intake forms are designed to capturekey information to create e�cient, insurance-friendly patient encounters.

Patient Handout(s):Patient-friendly handout(s) assist you and improvethe implementation of key lifestyle tips necessaryto correct underlying causes of illness.

Multi-Media Education:Choose the best format to suit your presentation style• Video + audio version• Presentation slides for custom educationIdeal use for a Group Visit or one-on-one setting

Shilpa P. Saxena, MD is a Board-Certi�ed Family Practice physician whose passion and purpose come to life through sharing her innovative patient education and practice management solutions in her classic ‘keep it simple’ style. She serves as Faculty with the Institute for Functional Medicine, the Arizona Center for Integrative Medicine, the University of Miami, Miller School of Medicine, and the Metabolic Medical Institute at George Washington University. Dr. Saxena is an expert in the Group Visit medical model, creator of Group Visit Toolkits, and co-author of The Ingredients Matter: India.

LT-Guide-Healthy Weight GVT

Patient Name: _________________________________ Date of visit: __________________________

CC: Overweight: BMI 27-30 Obese: BMI >30 Truncal weight gain

Associated Chronic Issue(s): 1. ___________________________ 2. __________________________________

History of Present Illness:

Part I: Physical Activity as Medicine

1. Please select the one choice that best describes you: o I’m physically active already and am happy with my progress. o I realize and am ready to get more active, but I would like some help. o I may not be ready to be more active, but I want to know if being more active would help my issues. o I’m not very active and not interested in being (or able to be) more active at this time.

2. How many hours each day do you spending sitting (e.g. watching TV, working at desk or on computer)? less than 1 hour 1-2 hours 2-4 hours more than 4 hours a day

3. How many minutes per week do you spend doing moderate physical activity (e.g. yard work, brisk walk, exercise class, sports)?

less than 30 min 30-90 min 90-150 min over 150 min

Part II: Food as Medicine:

1. Please select the one choice that best describes you: o I eat healthy with lots of fruits, veggies, clean protein, avoiding processed foods most of the time. o I am ready to eat healthier and would like more help and information on how to do it. o I may not be ready to be eat healthier, but I want to know if eating healthier would help my issues. o I’m not interested in changing the way I eat at this time.

2. How many servings of fruits and vegetables do you eat each day? (1 serving is approximately ½ cup)

2 or less 3-5 6-9 more than 9

3. How often do you eat foods that contain processed, preserved, or artificial ingredients? rarely or never once daily 2-4 x daily mostly all the time 4. How often to you drink fluids that contain sugar (including alcohol) or artificial ingredients?

rarely or never once daily 2-4 x daily mostly all the time

Review of Systems: (check all that apply)

fatigue chest pain with exertion joint pain swelling in legs/ankles acid reflux

snoring weight gain (last 3 mos): _____ # weight loss (last 3 mos): _____ #

Healthy Weight for Life

____________ (initial) I understand as a participant in this Group Visit/Shared Medical Appointment, that I and other patients will discuss medical information in the presence of other patients, family members, staff, and the clinician. If I have medical concerns that are of a very private nature, I will request to discuss with the clinician in a private setting or will schedule an individual office visit. I will also respect the confidentiality of the other members of the group by not revealing medical, personal, or any other identifying information about others in attendance after the session is over.

© 2015 Living Wellness, LLC GVT-5 Healthy Weight for Life-version 1.0

SOAP Note

a Insurance-friendly

a Can be scanned into EMR

a Patient completes

all non-gray box

sections

[ Insert Logo Here ]

ASSESSMENT (to be completed by office): Abnormal BMI Visceral Obesity Associated Chronic Disease(s) or Symptoms:

EXAM (to be completed by office):

o Vitals: Wt: _______ Ht: ________ BMI: _______ BP: _________ Pulse: ______ WC: ________ WHR: _______

o CV: R R R; no M/G/R Abnl: _____________ Edema: Yes / No JVD: Yes / No

o Respiratory: CTA B Abnl: ____________________ Respiratory Effort: WNL Labored o Other ____________________________________________________________________________________________

PLAN OF CARE (to be completed by office):

Reviewed common triggers of

inflammation, including excess adiposity Educated on inflammation as common

etiology of chronic disease Healthy support of detoxification &

elimination pathways discussed Low glycemic impact diet discussed Encouraged plant-based, whole foods

eaten in smaller portions & mindfully Take medications and/or supplements

as prescribed

RTC in _____ days weeks months

Provider to be seen: _______________________________

Reason for visit: ___________________________________

Other:

Everyone has his or her own special reason for looking and feeling better. Whether you’ve been recently diagnosed with a medical condition, want to keep up with your children/grandchildren or are just sick and tired of not feeling like ‘your old self’, making the choice to improve your health is a goal to be celebrated.

Patients with a clear understanding of what they deeply desire are the ones who succeed most often. Consider evaluating what fuels this quest and what will inspire and lift you hereafter by documenting them below: 1. Take a moment and reflect on why it is especially important to you to lose weight or live a healthier lifestyle?

2. Now, take a moment to reflect on how you will feel once you achieve your health goals.

© 2015 Living Wellness, LLC GVT-5 Healthy Weight for Life-version 1.0

Achieve a healthy weight and maintain it for life!Register for our upcoming patient Group Visit

Achieve a healthy weight and maintain it for life!Register for our upcoming patient Group Visit:t:

Did you know that more than 95% of people relapse from a fad diet in 5 years or less? Excessive calorie restriction, appetite suppressants and

short-term weight loss

health detriments.

Join us to learn how to avoid these pitfalls and embrace lifestyle choices that create lifelong, healthy weight and prevent chronic disease.

Healthy Weightfor Life

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fail to plan, plan to fail . . .Now  that  you  understand  your  motivation  for  making  your  commitment  to  

living  healthy,  it’s  important  to  understand  any  potential  challenges  that  may  arise  along  the  way.    Preparing  for  these  potential  stumbling  blocks  is  extremely  valuable  

because  you  will  know  exactly  how  you  plan  to  react  to  them  should  they  arise.  To  avoid  

this  ‘self-­‐sabotage’  unnecessarily,  plan  your  work  and  work  your  plan!  

“Give  me  six  hours  to  chop  down  a  tree  and  I  will  spend  the  first  four  sharpening  the  axe.”        ―  Abraham  Lincoln

©  2015  Living  Wellness,  LLC GVT-­‐5  Healthy  Weight  for  Life,  version  1.0

List the Challenges you may face and your plan for overcoming them them: Potential Challenge #1 è _________________________________________________________________- My plan to overcome this challenge:  

Potential Challenge #2 è _________________________________________________________________- My plan to overcome this challenge:  

Potential Challenge #3 è _________________________________________________________________- My plan to overcome this challenge:  

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ACTIVITY:    Exercise        �ty�e/ho�  long�� ACTIVITY:    Relaxation      �ty�e/ho�  long��

���

�aily  ��oal�

�rotein� Fruit� Nuts/  �ee�s�

Legumes/  �tarchy  Veg�

Whole  �rains�

Non-‐‑‒starchy  Veg� �airy� Fats/  

�ils�

�-‐‑‒�� �-‐‑‒�� �-‐‑‒�� �-‐‑‒�� �� unlimite�� �� �-‐‑‒��

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�          �          �          �          �          �          �          �          �          ���

h��  ��r�nu�u��y  ���  y�u  ���r������ h��  r������  ��r�  y�u  ����r��r�����          �          �          �          �          �          �          �          �          ���

(Hungry  scale:  1-­‐not  hungry  ;  10-­‐very  hungry)  )  

(Hungry  scale:  1-­‐not  hungry  ;  10-­‐very  hungry)  )  

(Hungry  scale:  1-­‐not  hungry  ;  10-­‐very  hungry)  )  

(Hungry  scale:  1-­‐not  hungry  ;  10-­‐very  hungry)  )  

(Hungry  scale:  1-­‐not  hungry  ;  10-­‐very  hungry)    

(Hungry  scale:  1-­‐not  hungry  ;  10-­‐very  hungry)  

(1-­‐not  very  relaxed  ;  10-­‐very  relaxed)  (1-­‐not  very  strenuous;  10-­‐very  strenuous)  

©  2015  Living  Wellness,  LLC   GVT-­‐5  Healthy  Weight  for  Life,  version  1.0  

 ©  2015  Living  Wellness,  LLC GVT-­‐5  Healthy  Weight  for  Life,  version  1.0

Making meaningful, healthy lifestyle changes is not always easy, especially as there

are many things to learn. Here are a few suggestions to keep it simple.

t ips for success

 

� Stop  sugary  or  diet  drinks.  

� Rid  your  home  or  office  of  unhealthy  ‘distractions’.  

� Drink  plenty  of  water:    ½  of  your  bodyweight  in  ounces  is  a  good  rule  of  thumb.  

� Understand  your  hunger/fullness.  Take  a  minute  right  now.    On  a  scale  of  1-­‐10,  how  full  are  you?    Use  this  to  evaluate  your  hunger  throughout  the  day.  

� Listen!    Really  listen  for  your  body  to  signal  that  it’s  hungry.    Don’t  confuse  boredom,  the  clock,  or  social  activities  as  hunger  queues.    Don’t  eat  until  you’re  hungry.    In  fact,  eat  when  you’re  between  2-­‐4  on  the  hunger/fullness  scale.    Any  lower  or  higher,  you’re  likely  to  overeat.  

� Stop  eating  at  about  a  6-­‐7  on  the  hunger/fullness  scale.    

� Stop  thoughts  that  sabotage  your  success.    These  thoughts  include,  “It’s  only  one”,  “I  had  a  hard  day,  I  deserve  this”,  “I  lost  weight  this  week”,  “I  don’t  want  to  hurt  her  feelings  by  declining”,  or  “I  just  don’t  care  right  now”  are  common.    

� Always  have  a  healthy  snack  nearby  –  a  piece  of  fruit  or  a  serving  of  nuts  or  seeds  could  be  just  what  you  need  in  an  unexpected  situation.  

� Food  is  either  helpful  or  hurtful  to  you.    Nourish  your  body  with  the  right  foods  and  be  aware  of  the  ‘foods’  you  know  are  harmful  to  you  in  the  end.  

� Don’t  comfort  yourself  with  food.    If  you  find  that  you’re  in  need  of  some,  find  another  way  to  help  yourself.    Go  for  a  brisk  walk,  do  yoga,  relax  &  breathe,  get  some  affection  from  someone  or  a  beloved  pet.    

� Last,  but  certainly  not  least,  be  kind  to  yourself  if  you  stumble.    Getting  healthy  is  rarely  a  straight-­‐line  journey.    Strive  to  spiral  up  accepting  occasional  drops.  If  you  fall,  be  sure  to  develop  a  clear  understanding  of  why  it  happened,  so  you  can  avoid  a  repeat  performance.    The  goal  is  to  keep  going!  

 

Your patients want to change…now you have the tools

• Overweight/Obese• Prediabetes/Type 2 Diabetes• Hypertension• Hyperlipidemia

• Coronary Heart Disease• Stroke• Liver and Gallbladder Disease• Osteoarthritis

• Gynecological problems• Cancer • Sleep Apnea and breathing problems

This essential toolkit educates patients on obstacles to achieving a healthy weight and maintaining it for life. By exploring in�ammation and detoxi�cation, patients will recognize patterns and long-term e�ects of unhealthy behaviors. Understanding the pitfalls of appetite suppressants and excessive calorie restriction will help patients embrace lifestyle choices that create lifelong, optimal body composition and chronic disease prevention. Use for patients with these issues:

THIS GROUP VISIT TOOLKIT INCLUDES:

© Living Wellness, LLC 2015. All rights reserved.

Visit Forms:Patient intake forms are designed to capturekey information to create e�cient, insurance-friendly patient encounters.

Patient Handout(s):Patient-friendly handout(s) assist you and improvethe implementation of key lifestyle tips necessaryto correct underlying causes of illness.

Multi-Media Education:Choose the best format to suit your presentation style• Video + audio version• Presentation slides for custom educationIdeal use for a Group Visit or one-on-one setting

Shilpa P. Saxena, MD is a Board-Certi�ed Family Practice physician whose passion and purpose come to life through sharing her innovative patient education and practice management solutions in her classic ‘keep it simple’ style. She serves as Faculty with the Institute for Functional Medicine, the Arizona Center for Integrative Medicine, the University of Miami, Miller School of Medicine, and the Metabolic Medical Institute at George Washington University. Dr. Saxena is an expert in the Group Visit medical model, creator of Group Visit Toolkits, and co-author of The Ingredients Matter: India.

LT-Guide-Healthy Weight GVT