RipotColonoscopy report template
Record bowel preparation, segmental findings, interventions and impressions in a reusable colonoscopy report.
Contributor: Ripot · Starter template
Preview and use →Gastroenterology · Contributor: Ripot
Flexible Sigmoidoscopy template
Document the examined lower bowel, preparation, extent, lesions, sampling and follow-up in an editable flexible sigmoidoscopy report.
Open an editable report in your browser, or download a printable PDF. The working template starts without clinical findings.
See the report
Actual PDF preview. Tap the page to enlarge. Complete only applicable fields.
Page 1 of 1
Copy a clean report outline
Clear headings and blank fields, ready to paste. Compatible editors also receive formatted text.
Read the blank outline
FLEXIBLE SIGMOIDOSCOPY Patient: ________________ Identifier: ________________ Date: ________________ PROCEDURE Indication: ________________ Consent and safety checks: ________________ Preparation and visibility: ________________ Sedation / analgesia: ________________ Extent and landmarks: ________________ Limitations / reason for stopping: ________________ FINDINGS Perianal inspection and digital examination: ________________ Rectum: ________________ Sigmoid colon: ________________ Additional bowel examined: ________________ Lesions: site, distance, size and morphology: ________________ SAMPLING AND INTERVENTIONS Biopsy taken: ________________ Sampling sites, number and specimen labels: ________________ Intervention and retrieval details: ________________ Immediate adverse events: ________________ CONCLUSION Impression: ________________ Plan and communication: ________________ Clinician: ________________ Signature: ________________
Flexible Sigmoidoscopy
Patient: ________________
Identifier: ________________
Date: ________________
Procedure
Indication: ________________
Consent and safety checks: ________________
Preparation and visibility: ________________
Sedation / analgesia: ________________
Extent and landmarks: ________________
Limitations / reason for stopping: ________________
Findings
Perianal inspection and digital examination: ________________
Rectum: ________________
Sigmoid colon: ________________
Additional bowel examined: ________________
Lesions: site, distance, size and morphology: ________________
Sampling and interventions
Biopsy taken: ________________
Sampling sites, number and specimen labels: ________________
Intervention and retrieval details: ________________
Immediate adverse events: ________________
Conclusion
Impression: ________________
Plan and communication: ________________
Clinician: ________________
Fictional example text
A demonstration of the layout using invented observations. It is not a patient report, normal-report default or clinical reference.
Read the fictional example
FLEXIBLE SIGMOIDOSCOPY FICTIONAL EXAMPLE - NOT FOR CLINICAL USE Illustrative content only; not a clinical reference. Patient: FICTIONAL PATIENT Identifier: DEMO-001 Date: 01 January 2026 PROCEDURE Indication: Intermittent rectal bleeding (fictional). Consent and safety checks: Consent and identity checks documented. Preparation and visibility: Enema preparation; visibility adequate in the examined segment. Sedation / analgesia: No intravenous sedation in this fictional examination. Extent and landmarks: Examined to 50 cm from the anal verge; proximal bowel not assessed. Limitations / reason for stopping: Examination limited to intended sigmoidoscopy extent. FINDINGS Perianal inspection and digital examination: No palpable mass in this fictional examination. Rectum: Small internal haemorrhoids seen on retroflexion. Sigmoid colon: Mucosa unremarkable within the examined segment. Additional bowel examined: No additional segment confidently identified. Lesions: site, distance, size and morphology: No polyp identified within the examined segment. SAMPLING AND INTERVENTIONS Biopsy taken: No Sampling sites, number and specimen labels: Not applicable. Intervention and retrieval details: None. Immediate adverse events: None observed. CONCLUSION Impression: Small internal haemorrhoids; proximal colon not evaluated. Plan and communication: Discuss findings and further evaluation with the referring clinician. No interval is prescribed by this example. Clinician: DEMONSTRATION ONLY - NOT SIGNED FICTIONAL EXAMPLE - NOT FOR CLINICAL USE
Flexible Sigmoidoscopy
FICTIONAL EXAMPLE - NOT FOR CLINICAL USE
Illustrative content only; not a clinical reference.
Patient: FICTIONAL PATIENT
Identifier: DEMO-001
Date: 01 January 2026
Procedure
Indication: Intermittent rectal bleeding (fictional).
Consent and safety checks: Consent and identity checks documented.
Preparation and visibility: Enema preparation; visibility adequate in the examined segment.
Sedation / analgesia: No intravenous sedation in this fictional examination.
Extent and landmarks: Examined to 50 cm from the anal verge; proximal bowel not assessed.
Limitations / reason for stopping: Examination limited to intended sigmoidoscopy extent.
Findings
Perianal inspection and digital examination: No palpable mass in this fictional examination.
Rectum: Small internal haemorrhoids seen on retroflexion.
Sigmoid colon: Mucosa unremarkable within the examined segment.
Additional bowel examined: No additional segment confidently identified.
Lesions: site, distance, size and morphology: No polyp identified within the examined segment.
Sampling and interventions
Biopsy taken: No
Sampling sites, number and specimen labels: Not applicable.
Intervention and retrieval details: None.
Immediate adverse events: None observed.
Conclusion
Impression: Small internal haemorrhoids; proximal colon not evaluated.
Plan and communication: Discuss findings and further evaluation with the referring clinician. No interval is prescribed by this example.
Clinician: DEMONSTRATION ONLY - NOT SIGNED
View all included fields
- Procedure
- Indication
- Consent and safety checks
- Preparation and visibility
- Sedation / analgesia
- Extent and landmarks
- Limitations / reason for stopping
- Findings
- Perianal inspection and digital examination
- Rectum
- Sigmoid colon
- Additional bowel examined
- Lesions: site, distance, size and morphology
- Sampling and interventions
- Biopsy taken
- Sampling sites, number and specimen labels
- Intervention and retrieval details
- Immediate adverse events
- Conclusion
- Impression
- Plan and communication
Using this reporting structure
Extent and visibility
Record the preparation, visibility, furthest landmark or distance reached, and any reason for stopping. This structure describes the examined lower bowel; it should not imply that the unexamined proximal colon was assessed.
Findings and specimens
Use separate entries for lesions, their size and morphology, interventions and labelled specimens. Link the impression to the observed findings and mention any limitation that affects interpretation.
Documentation help, not clinical guidance. Use current specialty guidance and local protocols. Review every report before signing or sharing.
Explore other templates
Upper GI endoscopy report template
An OGD / EGD reporting structure covering indication, sedation, anatomical findings, interventions and impression.
Contributor: Ripot · Starter template
Preview and use →Abdominal ultrasound report template
A reusable abdominopelvic ultrasound structure for organ findings, measurements and impression.
Contributor: Ripot · Starter template
Preview and use →Echocardiogram report template
A 2D echocardiography reporting structure for chamber measurements, function, valve findings and impression.
Contributor: Ripot · Starter template
Preview and use →Documentation references
Adapt these fields to your examination and local protocol. These editable structures have not undergone independent clinical validation; no organisation listed here endorses Ripot.