Application for designation as a freestanding BSCOE is voluntary. The process begins with centers applying first for Provisional Status when they can demonstrate to SRC that they have the resources to provide safe and effective bariatric surgery. These 13 requirements are listed on the left-hand menu under Provisional Status.

Provisional Status applications are reviewed by the Bariatric Surgery Review Committee (BSRC) and depending upon the information provided by the applicant, centers and surgeons may receive one of the following designations:

• Approved. These applicants may apply for Full Approval within two years.
  
  
• Denied. Denied applicants have six months to correct their deficiencies. They may request that their application be reviewed again, or they can appeal the decision to the Board of Directors.
  
  
• Monitoring Status. This designation is assigned by the BSRC when the surgery case volumes provided by an applicant appear to be insufficient to reach the required 100 cases per year (institution) or 50 cases per year/125 cases lifetime experience (surgeon) within the two-year Provisional Status period unless there is a significant increase in volume. Applicants are neither approved nor denied, but instead are asked to report their volumes in six months for re-evaluation.
  
  
• Pending Status. Applications can be placed in Pending Status when additional information is requested by the BSRC in order to make an accurate evaluation.

Provisional Status participants may apply for Full Approval when they can show that they have the experience necessary to provide safe and effective bariatric surgery based upon a review of their outcomes. Once the Full Approval application is received, a site inspection is conducted. The information collected during both the site inspection and Full Approval application is evaluated by the BSRC. The Committee may then recommend one of the following designations:

• Full Approval. This recommendation is forwarded to the ASMBS Executive Council for final consideration and vote.
  
  
• Denied. Applicants may request (1) that the application be reviewed again, (2) a second site inspection be conducted, and/or (3) an appeal to the Board of Directors. If denied, the institution will be placed back on Provisional Status.
  
  
• Pending Status. Reviewers may request additional information or a second site inspection.
  
  
• Probationary Status. Institutions that receive Provisional Status or Full Approval may lose that designation and be placed on Probationary Status when they no longer are able to meet the requirements. Failure to meet the standards within an acceptable period of time after being reduced to Probationary Status may result in a withdrawal of the designation. If the deficiencies are rectified within six months, Provisional Status or Full Approval will be reinstated.

Excellent bariatric surgery requires competent surgeons and well-prepared facilities. The application portfolio consists of three separate applications: one application submitted by each surgeon, one application submitted by the surgical practice or group and the remaining application by the institution (freestanding facility). Solo practitioners and surgeons employed directly by freestanding facilities must also complete and submit an individual surgeon application and a surgical practice application.

Centers missing any one of these three applications will not be able to submit their application portfolio.