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Bronchoscopy +/- Biopsy

(Affix identification label here) URN: Family name: Given name(s): Address: Date of birth: Sex: M F I Bronchoscopy +/- Biopsy Facility: Page 1 of 2 Continues over page 02/2011 The State of Queensland (Queensland Health), 2011 Permission to reproduce should be sought from DO NOT WRITE IN THIS BINDING MARGIN A. I nterpreter / cultural needs An Interpreter Service is required? Yes No If Yes, is a qualified Interpreter present? Yes No A Cultural Support Person is required? Yes No If Yes, is a Cultural Support Person present? Yes No B. Condition and treatment The doctor has explained that you have the following condition: (Doctor to document in patient s own words) .. This condition requires the following procedure. (Doctor to document - include site and/or side where relevant to the procedure) .. The following will be performed: The doctor uses a soft, thin, flexible fibre-optic tube (bronchoscope) to look at the vocal chords and airways.

• Narrowing of vocal cords (Laryngospasm). This is usually brief and rarely a problem. • Fever. This is treated with paracetamol (Panadol). • Death as a result of this procedure is rare. D. Significant risks and procedure options n Medical Record if necessary.)

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Transcription of Bronchoscopy +/- Biopsy

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