Interventional Gastroenterology Procedure Medical History Form

This interventional gastroenterology procedure medical history form is tailored for advanced endoscopy centers and gastroenterology practices performing complex therapeutic procedures beyond standard diagnostic endoscopy. The form collects critical information specific to high-risk interventional procedures such as endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound with fine needle aspiration (EUS-FNA), endoscopic mucosal resection (EMR), radiofrequency ablation (RFA), and peroral endoscopic myotomy (POEM). It emphasizes anticoagulation management, prior GI surgeries, and procedure-specific contraindications.

The template includes comprehensive sections for gastrointestinal symptom history, previous endoscopic procedures and complications, current anticoagulation and antiplatelet medications, bleeding disorder screening, cardiac and pulmonary comorbidities affecting sedation risk, anatomical considerations from prior surgeries, allergies to procedural medications, and procedure-specific preparation compliance. This form ensures interventional gastroenterologists have complete clinical information to assess procedural risk, plan appropriate anesthesia coordination, and optimize patient safety for complex therapeutic endoscopic interventions.