FEESability

Flexible Endoscopic Evaluation of Swallowing

Forms

Forms can make life easier!

For SLPs:

Referral Form — Use when requesting a FEES for your patient (complete as much as possible, but leaving blanks is okay!)

How to Write a Physician’s Order — Info sheet on how to write a physician’s order for FEES.

Resident Consent Form — Use to have documented consent for doing a FEES procedure.

FEES Patient info sheet — A single-page, easy to understand FEES info page to use with your patients (nice to use with above resident consent form).

Knowing Which Test to Order — An quick reference tool to help you decide which instrumental evaluation is best for your patient.

For Nursing & Medical Staff:

What is FEES? Why do FEES? — A concise intro to the FEES procedure. Consider including with physician’s orders or providing to facility staff / NPs / MDs.

How to Write a Physician’s Order — Info sheet on how to write a physician’s order for FEES.

For Facility Administration Staff:

Billing Procedures — A handy info sheet for your billing person

Facility Info — A single-page facility info page for FEESability’s quick reference

Service Agreement — A 6-page agreement between your facility and FEESability

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