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PRMC DISCLOSURE AND CONSENT FOR UPPER GASTROINTESTINAL ENDOSCOPY PROCEDURE WITH POSSIBLE ESOPHAGEAL DILATATION TO THE PATIENT: You have the right, as a patient to be informed about your condition
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How to fill out upper gastrointestinal endoscopy procedure

01
Make sure the patient has fasted for at least 6 hours before the procedure.
02
Have the patient change into a hospital gown.
03
Administer a sedative to help the patient relax and numb the throat.
04
Insert an endoscope through the mouth and into the esophagus, stomach, and duodenum.
05
Use the endoscope to examine the lining of the upper gastrointestinal tract and take samples if needed.
06
Remove the endoscope and monitor the patient's recovery.

Who needs upper gastrointestinal endoscopy procedure?

01
Individuals experiencing persistent abdominal pain or discomfort
02
Those with unexplained weight loss
03
Patients with difficulty swallowing
04
Individuals with gastrointestinal bleeding
05
Those with a history of gastrointestinal conditions such as ulcers or reflux disease
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Upper gastrointestinal endoscopy is a minimally invasive procedure that allows a doctor to examine the upper digestive tract, including the esophagus, stomach, and the first part of the small intestine, using a flexible tube with a camera.
Patients who undergo the upper gastrointestinal endoscopy procedure may need to file the procedure with their health insurance provider for coverage purposes, along with their healthcare provider or institution.
To fill out the upper gastrointestinal endoscopy procedure form, patients should provide personal details, medical history, the reason for the procedure, and consent to treatment, as required by the healthcare provider.
The purpose of upper gastrointestinal endoscopy is to diagnose and treat conditions affecting the upper gastrointestinal tract, such as ulcers, inflammation, tumors, and bleeding.
Information that must be reported includes the patient's personal and medical information, procedure indications, findings from the examination, any biopsy results, and the healthcare provider's recommendations.
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