This form is useful to inpatient/outpatient speech language pathologist that administer Modified Barium Swallow Studies.

Time is of the essence especially when you add in the radiology technician and/or radiologist time as well. Also, I have found over the years it is difficult to attain the background and personal medical history I need to achieve a thorough case history.

The goal of this form is to:

1) Streamline the intake process

2) Save you time in the radiology room

3) Decrease your chance of forgetting key background information

4) Help your patient focus on important things to talk about

I hope this helps you as much as it has us!

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