YOU HAVE BEEN SCHEDULED FOR AN EGD (GASTROSCOPY) EXAM

Patient Name: _______________________________            MDA_____           FMH____

Date of Procedure: _________________      Check-in time: ______________

Please call your insurance company to find out if pre-authorization is necessary for this procedure.  Bring any pre-authorization information and numbers, as well as you and your spouses Social Security number, employer name and phone numbers. Bring all current insurance/Medicare cards, or Medicaid coupon with you. To make, cancel or reschedule your procedure, please call Central Scheduling at 458-5588

YOUR MEDICATION

If you take Aspirin, Coumadin, Plavix, Ticlid, Persantine, Lovenox, or Heparin, please STOP these medicines 5 days prior to your gastroscopy.  You may continue to take your arthritis or anti-inflammatory medications. You may take all other medicines as long as they are taken at least six hours prior to the procedure.   No insulin or other diabetes medication should be take the morning of the procedure.

YOU MUST HAVE SOMEONE TO DRIVE YOU HOME.  YOU WILL NOT BE DISCHARGED WITHOUT A RIDE HOME.  YOU CANNOT TAKE A TAXI OR A BUS.

If you have any questions about this prep, please call FMH Outpatient Procedures at 458-5656, or the FMH procedure room at the Medical Dental Arts Building:  458-5620.

PREP INSTRUCTIONS

Eat a normal dinner the evening before.  Then, clear liquids only up until seven hours before check-in.  Please do not wear lipstick.

Alaska Medicine & Endoscopy, LLC, Arva Chiu, MD, www.akmedicine.com, 452-2637