Gastroenterology · Free template

Colonoscopy Report Template

A colonoscopy report is only as useful as its quality details: how good the bowel preparation was, whether the caecum was reached, how long the withdrawal took and exactly what was removed. This template puts those fields in front of you alongside the rectum, colon and terminal ileum findings.

Use this template free5 reports a month free · signed PDF · no card required

Sections in this colonoscopy report template

Indication & relevant history
Consent, sedation & bowel preparation
Extent, caecal landmarks & withdrawal time
Perianal region & rectum
- Normal: Perianal inspection and the rectal vault are normal.
- Haemorrhoids: Mild to moderate internal haemorrhoids are present without active bleeding.
- Proctitis: Diffuse rectal erythema, friability and loss of vascular pattern are consistent with proctitis.
Colon
- Normal: The scope was passed to the caecum. Colonic mucosa appears normal with preserved vascular detail.
- Diverticulosis: Multiple diverticula are present in the sigmoid and descending colon without diverticulitis.
- Polyp: A sessile polyp was identified and removed with cold snare polypectomy.
- Colitis: Segmental mucosal erythema, granularity and superficial ulceration are present.
Terminal ileum
- Normal: The terminal ileum demonstrates normal villous architecture.
- Ileitis: Aphthous ulceration and erythema are consistent with terminal ileitis.
Interventions, specimens & complications
Impression & follow-up plan

Quality-focused documentation outline. Confirm indication, bowel-preparation score, caecal landmarks, extent, withdrawal time, interventions, complications and the final plan for the procedure actually performed.

Quality details recorded

Withdrawal time (minutes)
Bowel-preparation scale and segment scores

Photo documentation checklist

Rectum
Caecum with appendiceal orifice
Ileo-caecal valve
Terminal ileum when intubated
Every polyp or abnormal finding
Resection site when treatment performed

How to use this template in MedPrax Report

Create a free account and choose Colonoscopy as the procedure.
Add the patient details, or pick a returning patient to reuse them.
Capture frames from a scope connected to your laptop, or upload images, and choose up to ten for the report.
Tap the common findings, then edit, type or dictate your own wording.
Review the report and download the signed PDF. Later corrections are added as amendments.

Frequently asked questions

What should a colonoscopy report include?

The indication, consent and sedation, bowel-preparation scale and score, extent reached with caecal landmarks, withdrawal time, findings by segment, polyps with size, site and removal technique, specimens, complications, and the follow-up or surveillance plan.

Does the template record withdrawal time and bowel preparation?

Yes. Withdrawal time and the bowel-preparation scale have their own fields, and a photo checklist covers the rectum, caecum with appendiceal orifice, ileo-caecal valve and every polyp.

Can I add colonoscopy images to the report?

Yes. Capture frames from a connected scope or upload images, then choose up to ten to include in the signed PDF.

Write your next colonoscopy report in minutes

Free for up to 5 reports a month. Paid plans from ₹999 / $19 for 30 days, with no automatic renewal.

Create free account

Related Gastroenterology templates

Upper GI Endoscopy Report Template

Missing a section you need?

Tell us what your colonoscopy report needs and we will consider it for the template.