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FSS Template Video fluoroscopic Swallowing Exam Name: ID/Medical record number: Date of exam: Referred by: Reason for referral: Medical diagnosis: Date of onset of diagnosis: Other relevant medical
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How to fill out videofluoroscopic swallowing exam template

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How to fill out videofluoroscopic swallowing exam template

01
To fill out the videofluoroscopic swallowing exam template, follow these steps:
02
Gather all the necessary information about the patient such as their medical history, current medications, and any existing medical conditions that may affect swallowing.
03
Start by providing the patient's basic details at the top of the template, including their name, age, and contact information.
04
Document the reason for the exam and any specific concerns or symptoms the patient is experiencing related to swallowing.
05
Describe the patient's current diet and any restrictions or modifications that have been made to accommodate their swallowing difficulties.
06
Outline the procedure and techniques used during the exam, including any contrast agents or specific imaging tools utilized.
07
Record the findings of the exam, including observations of the swallowing process, any abnormalities or difficulties encountered, and any specific recommendations or interventions suggested.
08
Summarize the overall assessment and include any follow-up recommendations or further diagnostic steps that may be necessary.
09
Sign and date the template to validate the documentation.
10
Review the completed template for accuracy and completeness before forwarding it to the relevant healthcare professionals or incorporating it into the patient's medical record.

Who needs videofluoroscopic swallowing exam template?

01
Videofluoroscopic swallowing exam templates are needed by healthcare professionals involved in the evaluation and management of patients with swallowing difficulties, also known as dysphagia.
02
This includes speech-language pathologists, radiologists, gastroenterologists, otolaryngologists, and other medical practitioners who perform or interpret videofluoroscopic swallowing exams.
03
Additionally, healthcare institutions, hospitals, and clinics often require standardized templates to ensure consistent and comprehensive documentation of these exams.
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