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THE GASTROENTEROLOGY CENTER OF VIRGINIA, LLC SURGICAL CONSENT FORM Patient Name Proposed ProcedureDateCOLONOSCOPY WITH POSSIBLE BIOPSYProposed ProcedureReferring MDD ate of BirthAgeSexSurgeonCONSENT
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How to fill out colonoscopy with possible biopsy

01
Follow the instructions provided by your healthcare provider before the colonoscopy.
02
Begin by emptying your bowels by following a specific diet or taking prescribed laxatives.
03
On the day of the colonoscopy, arrange for someone to drive you to and from the procedure as you will be sedated.
04
When you arrive at the medical facility, the healthcare team will explain the procedure and answer any questions you may have.
05
You will be asked to change into a hospital gown and lie on a procedure table.
06
A thin, flexible tube called a colonoscope will be gently inserted through your rectum into your colon.
07
The colonoscope has a light and a camera that allows your doctor to visualize the inside of your colon.
08
The doctor will carefully inspect the colon for any abnormalities, such as polyps or lesions.
09
If any polyps or suspicious areas are found, the doctor may decide to perform a biopsy.
10
During a biopsy, small tissue samples are taken for further examination in a laboratory.
11
After the procedure, you will be kept under observation until the sedation wears off.
12
You will be given instructions on post-procedure care and any potential side effects to watch out for.
13
Follow up with your healthcare provider to discuss the results of the colonoscopy and biopsy.

Who needs colonoscopy with possible biopsy?

01
Individuals who may need a colonoscopy with possible biopsy include:
02
- Those who have had abnormal results on previous colorectal screenings.
03
- Individuals with a family history of colorectal cancer or polyps.
04
- People with symptoms such as unexplained weight loss, abdominal pain, changes in bowel habits, or rectal bleeding.
05
- Those with certain medical conditions, such as inflammatory bowel disease.
06
- Individuals above a certain age, as recommended by their healthcare provider for routine screening.
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- Those who have been identified as high risk based on other factors determined by their healthcare provider.
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Colonoscopy with possible biopsy is a medical procedure where a flexible tube with a small camera is inserted into the colon to look for abnormalities. If any suspicious areas are found, a tissue sample may be taken for further analysis (biopsy).
Medical professionals performing a colonoscopy with possible biopsy are required to file the procedure and any biopsy results.
The medical professional needs to document details such as patient information, date of the procedure, findings during the colonoscopy, and any biopsy results.
The purpose of colonoscopy with possible biopsy is to screen for colon cancer, investigate symptoms such as bleeding or pain, and diagnose conditions like inflammatory bowel disease.
Information such as patient demographics, procedure details, findings during the colonoscopy, biopsy results, and any follow-up recommendations must be reported.
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