Informed consent for diagnostic or therapeutic colonoscopy, including bowel preparation instructions, procedure risks, alternatives, and patient acknowledgment.
The Colonoscopy Informed Consent is a ready-to-use healthcare & wellness template you can send for signature in minutes. It is written for 1 signer (patient) and, by default, expires 30 days after it is sent if left unsigned. It covers consent, gastroenterology, colonoscopy, endoscopy, healthcare. Like every Abundera Sign template it is a convenience draft structured for ESIGN Act and UETA compliance, not a substitute for legal advice. Each signed copy is sealed with PAdES-LTA digital signatures, dual RFC 3161 timestamps, and a tamper-evident evidence package in WORM storage.
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# Colonoscopy Informed Consent > **Important — not medical advice.** For use by a licensed provider; tailor risks/benefits/alternatives to the patient and your institution's protocols and state law. **Patient Name:** ___________ **Date of Birth:** ___________ **Medical Record Number:** ___________ **Ordering Physician:** ___________ **Scheduled Procedure Date:** ___________ --- ## 1. Description of the Procedure A colonoscopy is a visual examination of the lining of the large intestine (colon) and rectum using a flexible, lighted tube called a colonoscope. The colonoscope is inserted through the rectum and advanced through the entire colon to the cecum (and often the terminal ileum). The physician can inspect the mucosal lining, obtain tissue samples (biopsies), remove polyps (polypectomy), control bleeding, dilate strictures, or perform other therapeutic interventions during the same examination. The procedure requires complete bowel cleansing beforehand. Sedation (typically moderate or deep) is used to minimize discomfort. **Indication(s) for this procedure:** ___________ --- ## 2. Expected Benefits Colonoscopy is the most accurate test available for evaluating the colon. Potential benefits include: - Detection and removal of precancerous polyps, which can prevent colorectal cancer - Diagnosis of colorectal cancer at an early, treatable stage - Evaluation of unexplained gastrointestinal bleeding, chronic diarrhea, or abdominal pain - Assessment of inflammatory bowel disease (Crohn's disease, ulcerative colitis) - Surveillance following prior polyp removal or colorectal cancer resection - Therapeutic intervention (e.g., hemostasis, stent placement, foreign body retrieval) ---