QPC Colorectal Screening Refusal Form

Refusal Form

Colorectal Screening

that it is recommended for a colon screening be performed on a regular basis. All insurances recommended colorectal screenings for patients between the ages of 50-75 years old. The following is the normal time frame recommended by insurance companies for each of the different kinds of colorectal screenings.

1. Colonoscopy should be performed every Ten years.
2. Sigmoidoscopy every Five years
3. Cologuard every Three years
4. Fecal occult testing (FOBT) once a year.

Regular screenings ar

I understand that without the colorectal screenings the detection of cancer will not be identified. I confirm with my signature that: The physician has discussed the above information with me, that I have had the chance to ask questions, that all of my questions have been answered to my satisfaction, and that I voluntarily refuse testing for colorectal screenings.