1. Date of procedure(s)

2.a GI Procedure

If other GI endoscopic procedure, specify:

2.b Reason for GI procedure: [1] Routine screening study

2.b Reason for GI procedure: [2] Procedure for surveillance for Barrett's esophagus

2.b Reason for GI procedure: [3] Procedure for surveillance for family history of colorectal cancer

2.b Reason for GI procedure: [4] Procedure that was prompted by blood in stool or evidence of GI bleeding (upper or lower)

2.b Reason for GI procedure: [5] Procedure that was prompted by anemia

2.b Reason for GI procedure: [6] Procedure that was prompted by difficulty swallowing

2.b Reason for GI procedure: [7] Procedure that was prompted by esophageal reflux

2.b Reason for GI procedure: [8] Procedure that was prompted by diarrhoea

2.b Reason for GI procedure: [9] Procedure that was prompted by abdominal pain

2.b Reason for GI procedure: [UNK] Unknown

2.b Reason for GI procedure: [OT] Procedure that was precipitated by other symptom or finding

2.b Reason for GI procedure: If Procedure that was precipitated by other symptom or finding, specify

3. Was a cancer identified?

4. Was a benign GI polyp(s) (1), a benign GI neoplasms(s) or a neoplasm(s) unable to be determined as benign or malignant identified?