Ripot
Endoscopy · Contributor: Ripot

Colonoscopy report template

Record bowel preparation, segmental findings, interventions and impressions in a reusable colonoscopy report.

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Structure preview · No patient data

Lower GI Endoscopy

Patient: ____________________
Identifier: __________________
Date: ______________________

Report sections

  1. Indication
  2. Premedication / Sedation
  3. Bowel preparation
  4. Extent of examination
  5. Findings
  6. Polyp identified
  7. Polyp site
  8. Number of polyps
  9. Largest polyp size
  10. Polyp morphology
  11. Polypectomy performed
  12. Biopsy taken
  13. Biopsy site
  14. Other intervention
  15. Assessment / Impression
  16. Recommendation

Clinician: __________________
Signature: _________________

Included fields

Copy the blank report outline

A reusable starting point, without prefilled normal findings. Complete and check each section for the examination performed.

Patient name: [enter]
Patient identifier: [enter]
Report date: [enter]
Indication: [enter]
Premedication / Sedation: [enter]
Bowel preparation: [enter]
Extent of examination: [enter]
Findings: [enter]
  Perianal region: [enter]
  Rectum: [enter]
  Sigmoid colon: [enter]
  Descending colon: [enter]
  Transverse colon: [enter]
  Ascending colon: [enter]
  Caecum: [enter]
  Terminal ileum: [enter]
Polyp identified: [enter]
Polyp site: [enter]
Number of polyps: [enter]
Largest polyp size: [enter]
Polyp morphology: [enter]
Polypectomy performed: [enter]
Biopsy taken: [enter]
Biopsy site: [enter]
Other intervention: [enter]
Assessment / Impression: [enter]
Recommendation: [enter]
Impression: [enter]
Signed by: [enter]

Illustrative report layout (fictional)

Not a patient report, verified normal findings, or a PDF exported by Ripot. This is a text-only layout example; always document actual observations.

SAMPLE ONLY · NOT FOR CLINICAL USE

Demonstration colonoscopy report

Indication: Screening examination
Extent: Caecum reached; landmarks documented
Bowel preparation: Adequate (illustrative only)
Findings: Example text only — enter observed segmental findings
Interventions: None in this fictional example
Impression: Example for layout demonstration, not a clinical result

Clinician: [example] · Signature: [not signed]

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