Get the free DEFECOGRAPHY QUESTIONNAIRE - cedars-sinai

DISCOGRAPHY QUESTIONNAIRE Fluoroscopy or Dynamic Pelvic MR PATIENT I.D. Please answer yes or no. Some questions require you to circle the best answer. 1. Do either of these situations apply to you?

How to fill out defecography questionnaire - cedars-sinai

Point by point, here is how to fill out the defecography questionnaire from Cedars-Sinai:

1. Start by carefully reading through the entire questionnaire to familiarize yourself with the questions and format.
2. Begin by providing your personal information, such as your name, date of birth, and contact details. This information is crucial for accurately identifying and communicating with you.
3. The questionnaire may ask for specific medical history details related to your bowel movements or any previous surgeries or procedures you have undergone. Be sure to answer these questions honestly and to the best of your knowledge.
4. You may be asked to rate the severity of certain symptoms, such as constipation, bloating, or pelvic pain, using a scale or descriptive terms. Take your time to reflect on your experience and choose the option that most accurately represents your situation.
5. Some questions may require you to provide specific details or descriptions of your bowel movements, such as frequency, consistency, and any difficulties or straining experienced. Share any relevant information that might help healthcare providers understand your symptoms better.
6. The questionnaire could inquire about lifestyle factors that may affect your bowel health, such as diet, exercise, and stress levels. Provide as much detail as possible to offer a comprehensive picture of your overall well-being.
7. Towards the end of the questionnaire, there may be sections for additional comments or concerns. Feel free to use these spaces to elaborate on any relevant information or provide further context.

Who needs the defecography questionnaire from Cedars-Sinai?

1. Individuals experiencing bowel movement difficulties such as constipation, diarrhea, or fecal incontinence
2. Those with symptoms or conditions related to pelvic floor dysfunction
3. Patients scheduled for or considering defecography or related diagnostic tests at Cedars-Sinai Medical Center
4. Anyone seeking a comprehensive assessment and management of their bowel health and related issues

It is important to note that the defecography questionnaire from Cedars-Sinai is specifically designed for their patients or individuals undergoing procedures at their medical center. It is always recommended to consult with a healthcare professional or follow instructions provided by your healthcare provider regarding any specific questionnaires or forms.

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