Practice name:
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Name of person completing this EOI:
Does your practice have the ability within the next three months to recruit 10 patients at risk of metabolic syndrome?
Does your practice have the ability within the next three months to schedule x10 case conference consultations, and x10 follow up consultations at six months?
Do you have GP/s with the capacity to participate in a total of ten x 40-minute case conference consultations in three months time?
Do you have GP/s with the capacity to participate in a total of 10x 20-minute case conference consultations six months after the initial case conference?
Do you have a regular dietician you refer to?
Do you have a regular exercise physiologist that you refer to?
If the dietician and exercise physiologist you refer to are not interested in participating in this program, are you happy for your patients to see other dieticians and exercise physiologists (for purposes of this program)?
Please outline the number of patients at your practice who you believe are at risk of metabolic syndrome:
Please detail how you would identify patients (at risk of metabolic syndrome) to participate in this program:
Please outline why you feel that your practice and patients would benefit from participating in this program:
In applying for this grant, I accept all of the criteria below:
Do you acknowledge that if successful the practice will need to provide SWSPHN with: