Get the free Flexible Sigmoidoscopy Referral Form - InHealth Group

Prime Endoscopy Bristol Flexible Sigmoidoscopy Referral Form Patient Name: Date of birth: Address: GP Name: GP Address: Postcode: Postcode: Tel No: Tel No: Mobile: NHS Number: Fax Number: This procedure

How to fill out flexible sigmoidoscopy referral form

How to fill out a flexible sigmoidoscopy referral form:

1. Gather all necessary information: Before starting to fill out the form, make sure you have all the required information handy. This may include the patient's personal details like name, age, address, contact number, and insurance information.
2. Indicate the reason for the referral: On the form, there should be a specific section where you can state the reason for the flexible sigmoidoscopy referral. Provide clear and concise information regarding the symptoms or medical history that necessitate this referral.
3. Enter referring physician details: In this section, you will need to provide the contact information and details of the healthcare professional who is referring the patient for the flexible sigmoidoscopy. Include their name, address, phone number, and any other pertinent information.
4. Include patient medical history: It is essential to provide a comprehensive medical history of the patient. This may include any relevant pre-existing conditions, surgeries, allergies, medications, or ongoing treatments. The more information you can provide, the better it will assist the doctor in making an accurate diagnosis.
5. Provide any additional notes: If there are any specific concerns or additional information that you believe is necessary for the doctor to know, make sure to mention it in the designated section. This can be particularly helpful when it comes to any specific symptoms or previous tests or procedures that have been conducted.

Who needs a flexible sigmoidoscopy referral form?

1. Individuals experiencing gastrointestinal symptoms: Anyone who is experiencing gastrointestinal symptoms like abdominal pain, rectal bleeding, changes in bowel habits, or unexplained weight loss may require a flexible sigmoidoscopy referral. These symptoms could indicate underlying conditions that warrant further investigation.
2. Patients with a positive fecal occult blood test (FOBT): If a patient has undergone a fecal occult blood test and the results are positive, a flexible sigmoidoscopy referral may be necessary. This is done to assess the source of the bleeding and determine the appropriate course of treatment.
3. Individuals at higher risk of colorectal cancer: Certain individuals may be at a higher risk of developing colorectal cancer due to factors such as age, family history, or prior history of polyps. In such cases, a flexible sigmoidoscopy referral may be recommended as a preventive measure or to screen for any potential abnormalities.

In summary, to fill out a flexible sigmoidoscopy referral form, gather necessary information, state the reason for the referral, provide referring physician details, include patient medical history, and add any additional notes. This form is typically required for individuals experiencing gastrointestinal symptoms, those with a positive FOBT, and those at higher risk of colorectal cancer.

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What is flexible sigmoidoscopy referral form?

Flexible sigmoidoscopy referral form is a document used to refer a patient to undergo a flexible sigmoidoscopy procedure.

Who is required to file flexible sigmoidoscopy referral form?

Medical professionals such as doctors or specialists are required to file flexible sigmoidoscopy referral form.

How to fill out flexible sigmoidoscopy referral form?

To fill out a flexible sigmoidoscopy referral form, the medical professional must provide the patient's information, reason for referral, and any relevant medical history.

What is the purpose of flexible sigmoidoscopy referral form?

The purpose of flexible sigmoidoscopy referral form is to facilitate the process of referring a patient for a flexible sigmoidoscopy procedure.

What information must be reported on flexible sigmoidoscopy referral form?

The flexible sigmoidoscopy referral form must include the patient's name, date of birth, contact information, reason for referral, and any relevant medical history.