Barium swallow report template 2026

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  1. Click ‘Get Form’ to open the barium swallow report template in the editor.
  2. Begin by entering the patient's personal information, including their name, ID/medical record number, and date of exam. This foundational data is crucial for accurate record-keeping.
  3. In the 'Reason for referral' section, specify why the patient is being evaluated. Include any relevant medical history or diagnoses that may impact swallowing.
  4. Proceed to the 'Subjective/Patient Report' section. Here, check all symptoms reported by the patient such as drooling, coughing, or difficulty swallowing solids and liquids.
  5. Fill out dietary preferences under 'Current diet.' Indicate whether the patient consumes regular solids or requires modified textures like pureed foods.
  6. Complete observations regarding mental status and endurance during meals. This helps assess the patient's overall condition and ability to participate in swallowing evaluations.
  7. Finally, review all sections for accuracy before saving or sharing the completed report. Utilize our platform's features to easily export or distribute your document as needed.

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You will be given a thinner barium drink to swallow. The radiologist will use X-rays or fluoroscopy to watch the barium go down your esophagus. You may also be asked to swallow a barium tablet. This is a small pill that can help to show certain problems in the esophagus.
Read the form carefully and ask questions if anything is not clear. You will need to stop eating and drinking for about 8 hours before the swallowing test. Generally, this means after midnight. Tell your provider if you are pregnant or think you may be pregnant before scheduling a barium swallow test.
How do I prepare for a barium swallow? Please do not eat or drink for a minimum of 4 hours before your appointment time. If you need to, you can take small sips of water or clear fluid. Diabetic patients to ensure blood sugars are maintained.

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A normal result means that no abnormalities in size, shape, and movement were found in your upper GI tract. If your results were not normal, it may mean you have one of the following conditions: Hiatal hernia. Ulcers.
For a satisfactory exam, your stomach must be empty. It is important that you not eat or drink anything for four hours before your exam. Additionally, do not use gum, mints or cigarettes after midnight the night before your exam. If your doctor gave you an order, please bring it with you.
The videofluoroscopic swallowing study (VFSS), also known as the modified barium swallow study, is a radiographic procedure that provides a direct, dynamic view of oral, pharyngeal, and upper esophageal function (Logemann, 1986).

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