Get the free Request for Upper Endoscopy or Colonoscopy - dukehealth

A form used by healthcare providers to request scheduling of upper endoscopy or colonoscopy procedures at Duke University Medical Center, including patient information and clinical indications.

How to fill out request for upper endoscopy

How to fill out Request for Upper Endoscopy or Colonoscopy

1. Obtain the Request for Upper Endoscopy or Colonoscopy form from your healthcare provider.
2. Enter the patient's personal information, including name, date of birth, and insurance details.
3. Specify the type of procedure being requested: Upper Endoscopy or Colonoscopy.
4. Provide relevant medical history, including symptoms and previous procedures if applicable.
5. Indicate the reason for the procedure in detail.
6. Fill out any additional required sections such as allergy information and medications.
7. Review the form for accuracy and completeness.
8. Sign and date the form where indicated.
9. Submit the form to the healthcare facility or physician's office as directed.

Who needs Request for Upper Endoscopy or Colonoscopy?

1. Individuals experiencing gastrointestinal symptoms such as persistent abdominal pain, difficulty swallowing, or unexplained weight loss.
2. Patients with a history of gastrointestinal diseases or conditions, such as Crohn's disease or ulcerative colitis.
3. Individuals over the age of 50, or younger individuals with a family history of colorectal cancer, for routine screening.
4. Patients requiring follow-up for previous gastrointestinal issues or procedures.

People Also Ask about

How do you get an upper endoscopy?

Your GP may refer you for an endoscopy if you're having certain symptoms. It will usually be done at an endoscopy unit in a hospital. There are different types of endoscopy that look at different parts of the body. The type of endoscopy you have will depend on your symptoms.

Do they put you to sleep for an upper endoscopy?

An upper endoscopy is typically an outpatient procedure, meaning you go home the same day. The procedure may be uncomfortable, but it shouldn't be painful.

What is the difference between an endoscopy and an upper endoscopy?

It should take 15 to 45 minutes to have your gastroscopy. But you might be at the hospital for around 4 hours from the time you get there until you go home. Information: A gastroscopy should not be painful.

How painful is an upper endoscopy?

The main difference lies in the specific areas of the body they examine. EGD focuses solely on the upper gastrointestinal tract. It includes the esophagus, stomach, and duodenum. Endoscopy, on the other hand, can be used to examine various parts of the body beyond the digestive system.

What is another name for an upper endoscopy?

Your gastroenterologist may recommend that you get an endoscopy if you are dealing with: Unexplained abdominal pain. Persistent changes (diarrhea; constipation) Chronic heartburn or chest pain. Signs of an intestinal bleed or blockage. Blood in the stool. A family history of colon cancer.

For pdfFiller’s FAQs

What is Request for Upper Endoscopy or Colonoscopy?

A Request for Upper Endoscopy or Colonoscopy is a formal document that is submitted by a healthcare provider to schedule these diagnostic procedures. Upper endoscopy involves examining the upper gastrointestinal tract, while colonoscopy examines the lower gastrointestinal tract.

Who is required to file Request for Upper Endoscopy or Colonoscopy?

Typically, a healthcare professional such as a physician, gastroenterologist, or specialist is required to file the Request for Upper Endoscopy or Colonoscopy on behalf of the patient who requires the procedure.

How to fill out Request for Upper Endoscopy or Colonoscopy?

To fill out the Request for Upper Endoscopy or Colonoscopy, the healthcare provider must provide patient information, medical history, reason for the procedure, and any relevant clinical findings. Specific forms may vary depending on the healthcare institution.

What is the purpose of Request for Upper Endoscopy or Colonoscopy?

The purpose of the Request for Upper Endoscopy or Colonoscopy is to obtain approval and schedule the procedure needed to diagnose or treat gastrointestinal conditions, assess symptoms or abnormalities, and facilitate further management.

What information must be reported on Request for Upper Endoscopy or Colonoscopy?

Required information often includes patient demographics, medical history, indication for the procedure, any previous procedures done, medications, and pertinent laboratory results.