| Document Date: 2013-08-27 18:41:46
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City Physician / / Company Wellpoint / Humana / Aetna / Cigna / / Facility Quality Improvement Consortium Colonoscopy Data Collection Form Endoscopy Suite Information Endoscopy Facility / Non-Teaching Facility / Teaching Facility / Hospital Admission / / IndustryTerm e.g. polypectomy site / polypectomy site / / MedicalCondition Unexplained iron deficiency anemia / neoplasms / adenoma / Clinically significant diarrhea / acute nontoxic megacolon / adenomas / Inflammatory bowel disease / Colon Adenoma / disease / neoplasm / sided colitis / Both High Risk Genetic Family Cancer Syndrome / vascular malformation / More Adenomas / Colon Cancer / sigmoid volvulus / Adenomatous Polyp / HNPCC/Lynch Syndrome / Both Advanced Neoplasm / OR traditional serrated adenoma / Non Advanced Neoplasm / Serrated polyposis syndrome / Rectal Adenocarcinoma / Tubular Adenomas / Familial Adenomatous Polyposis Syndrome / Adenocarcinoma / / MedicalTreatment enema / surgery / Balloon dilation / / Organization World Health Organization / Physician Office / Medicare / / Position Fellow Physician / Hospital Physician / Nurse / Surgeon / General / General Quality Indicators Procedure Date / / Product propofol / / ProgrammingLanguage FP / / ProvinceOrState Alaska / /
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GI Quality Improvement Consortium Colonoscopy Data Collection Form Patient Sociodemographic Information Patient Identifier: Inpatient Outpatient