Get the free Modified Barium Swallow Study Authorization Form #2.doc

Diagnosed Authorization/Consent Form Please read thoroughly Patient or Responsible Party must initial all bulleted items and sign at the bottom of the page This signed documents grants the following

How to fill out modified barium swallow study

To fill out a modified barium swallow study, follow these steps:

1. Begin by gathering the necessary information and documentation. This may include the patient's medical history, current medications, and any relevant imaging or test results.
2. Next, prepare the patient for the procedure. This typically involves explaining the purpose of the study, obtaining informed consent, and addressing any concerns or questions they may have.
3. Once the patient is ready, it is important to ensure their safety during the procedure. This may involve adjusting the examination table or wheelchair to the appropriate height and positioning, as well as taking necessary precautions for patients with physical limitations or swallowing difficulties.
4. The modified barium swallow study typically involves administering various food and liquid consistencies mixed with a contrast agent, such as barium sulfate. Ensure that the appropriate consistency and amount of contrast agent is used, as determined by the patient's specific needs and swallowing abilities.
5. Throughout the study, carefully observe and document the patient's swallowing function and any signs of aspiration or difficulties. This may involve using imaging techniques, such as fluoroscopy or video fluorography, to visualize the movement of food and liquid as the patient swallows.
6. Record any abnormalities or findings during the study, such as delayed swallowing, aspiration, or difficulties with certain consistencies. Make note of any recommendations or modifications needed to improve the patient's swallowing function.

Who needs a modified barium swallow study:

1. Patients with known or suspected swallowing difficulties, such as dysphagia, vocal cord dysfunction, or neurological disorders.
2. Individuals who have experienced recurrent aspiration pneumonia or frequent choking episodes.
3. Patients who have undergone surgery or treatment for head and neck cancer, as swallowing function may be impaired.
4. People with certain medical conditions, such as stroke, multiple sclerosis, or Parkinson's disease, which can affect swallowing ability.
5. Individuals who have experienced a recent change in oral intake or have concerns regarding their ability to safely swallow.

In summary, filling out a modified barium swallow study involves obtaining relevant information, preparing the patient, administering contrast agents, observing and documenting swallowing function, and making appropriate recommendations. This procedure is commonly needed by individuals with swallowing difficulties or specific medical conditions that may affect their ability to swallow safely.

For pdfFiller’s FAQs

What is modified barium swallow study?

Modified barium swallow study is a radiologic procedure used to evaluate swallowing function and diagnose swallowing disorders.

Who is required to file modified barium swallow study?

Patients who are experiencing difficulty swallowing or have been diagnosed with a swallowing disorder may be required to undergo a modified barium swallow study.

How to fill out modified barium swallow study?

A modified barium swallow study is typically conducted by a radiologist and a speech-language pathologist. The patient will be asked to swallow a specialized barium mixture while being monitored with fluoroscopy.

What is the purpose of modified barium swallow study?

The purpose of a modified barium swallow study is to assess the patient's ability to swallow safely and effectively, identify any potential issues or abnormalities in the swallowing process, and guide treatment and management strategies.

What information must be reported on modified barium swallow study?

The modified barium swallow study report should include details regarding the patient's swallowing function, any abnormalities observed during the procedure, recommendations for treatment or further evaluation, and follow-up plans.

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