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Case Review Form
Contact Information

In a few sentences, what prompted you to request a Case Review? What would you most like Dr. Hodges to address?

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Examples:

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“Our son is 10 and has never had a dry night. Our doctor says he’ll outgrow it, but we’re losing confidence and aren’t sure where to start. Desmopressin didn’t help, and we’re unsure whether M.O.P. is necessary.”

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“My daughter’s poop accidents stopped on Standard M.O.P. 6 months ago, but she still wets at night. We started Multi-M.O.P. 2 months ago with no improvement. Our doctor says the x-ray shows ‘moderate stool burden’ and is basically normal. We’d like you to review the x-ray and advise on next steps.”

Current Symptoms

Which of the following have you noticed? (Check all that apply.) You can add more details below if helpful.

Pooping difficulties
Urgent need to pee
Excessively frequent need to pee
Recurrent urinary tract infections (UTIs)
X-ray evaluation (optional)

If you have an abdominal x-ray, you may upload it here for Dr. Hodges to review.

There is no need to include any written report you previously received, but feel free to summarize any conclusions you were given regarding stool burden or rectal diameter.

Upload File
Upload supported file (Max 15MB)
Treatment History

Please list your child’s current treatments (e.g., enemas, Miralax, Ex-Lax, timed toileting, bedwetting alarm, medication, behavioral therapy, dietary changes, etc.)

Bullet points are fine — no need for a long narrative

Relevant Medical Conditions
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