The Gastric Bypass Informed Consent is a ready-to-use healthcare & wellness template you can send for signature in minutes. It is written for 1 signer (patient) and, by default, expires 30 days after it is sent if left unsigned. It covers consent, bariatric, gastric bypass, weight loss surgery, surgical, metabolic. Like every Abundera Sign template it is a convenience draft structured for ESIGN Act and UETA compliance, not a substitute for legal advice. Each signed copy is sealed with PAdES-LTA digital signatures, dual RFC 3161 timestamps, and a tamper-evident evidence package in WORM storage.
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# Gastric Bypass Informed Consent > **Important — not medical advice.** For use by a licensed provider; tailor to the patient, your protocols, and state law. **Patient Name:** ___________ **Date of Birth:** ___________ **Procedure Date (anticipated):** ___________ **Surgeon:** ___________ **Current weight:** ___________ **Current BMI:** ___________ --- ## 1. Procedure Description Roux-en-Y gastric bypass (RYGB) is a bariatric surgical procedure that combines a restrictive and malabsorptive mechanism to achieve sustained weight loss and metabolic improvement. The procedure creates a small gastric pouch (15–30 mL) from the upper stomach, which is then connected directly to a limb of the small intestine (Roux limb), bypassing the remainder of the stomach, the duodenum, and the proximal jejunum. A second intestinal connection (jejuno-jejunostomy) restores intestinal continuity. The procedure is performed laparoscopically in most cases; conversion to open surgery may be required. **Planned approach:** ___________ --- ## 2. Indications Bariatric surgery is generally indicated for patients who meet at least one of the following criteria, as established by NIH and professional society guidelines: - BMI ≥ 40 kg/m² - BMI ≥ 35 kg/m² with one or more obesity-related comorbidities (type 2 diabetes, hypertension, obstructive sleep apnea, non-alcoholic fatty liver disease, hyperlipidemia, osteoarthritis, or others) - BMI 30–34.9 kg/m² with poorly controlled type 2 diabetes or metabolic syndrome (emerging guideline criterion) **Documented indication(s) for this patient:** ___________ I have completed the required pre-operative evaluation including nutritional counseling, psychological evaluation, and medical clearance.