Name: __________________________ Institution: 1. 2. 3. 4. No. Date Patient Submit Complete Indication Result Abnormality __/__/__ Age Studies Only (See Below) (See Below) (See (See Below) A = Anaemia Views to colon: Result: V = Vascular P = Polyp Indicate 10 abnormal P = PJS Y = Yes N = Normal I = Inflammatory Blank = no abnormality cases with an O = Obscure Bleeding N = No Ab = Abnormal Other Supply text – N = Neoplastic “x” Other Supply text – 2.
Name: __________________________ Institution: No. Date __/__/__ Patient Age 1. Indication (See Below) 2. Submit Complete Studies Only (See Below) 3. Result (See Below) 4. Abnormality (See A = Anaemia P = PJS O = Obscure Bleeding Other – Supply text Views to colon: Y = Yes N = No Result: N = Normal Ab = Abnormal V = Vascular I = Inflammatory N = Neoplastic P = Polyp Blank = no abnormality Other – Supply text Indicate 10 abnormal cases with an “x” 2.
capsule-endoscopy-logbook.docx