|
Reason for Colposcopy:
|
Reason Comment:
|
|
T-Zone Visible?
|
Visualization Comment:
|
|
Biopsies Obtained?
|
Comment(s):
|
|
Biopsy Site A:
|
Site A Visual Findings:
|
|
Biopsy Site B:
|
Site B Visual Findings:
|
|
Biopsy Site C:
|
SIte C Visual Findings:
|
|
Biopsy Site D:
|
Site D Visual Findings:
|
|
Biopsy Site E:
|
Site E Visual Findings
|
|
ECC Done?
|
|
|
Monsel's?
|
|
|
Assessment:
• • •
|
Comment(s):
|
|
Successful Colposcopy & Plan?
|
Inadequate Colposcopy & Plan?
|
