YOU HAVE BEEN SCHEDULED FOR A COLONOSCOPY 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
If you take Aspirin, Coumadin, Plavix,
Ticlid, Persantine, Lovenox, or Heparin, please STOP these medicines 5 days
prior to your colonoscopy. You
may continue to take your arthritis or anti-inflammatory medications. Please stop taking any iron pills 5 days before your procedure. Diabetic
patients should take ½ of the usual dose of insulin or other diabetic
medications while on the clear liquid diet.
No insulin or other diabetes medication should be take the morning of
the procedure.
YOUR DIET
Avoid eating nuts, seeds, grapes, beans, green peas, salads (and other raw vegetables), tomatoes and vitamins 3 days before your procedure.
If you have any questions about the instructions, please
call FMH Outpatient Procedures at 458-5656, or the FMH procedure room at the
Medical Dental Arts Building: 458-5620.
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.
THE PREP:
Purchase two bottles of FLEET Phospho-Soda
Buffered Laxative (45 ml per bottle) at any pharmacy and chill them before
drinking.
THE DAY BEFORE THE PROCEDURE:
Start a clear liquid diet in the morning:
you may drink water, bouillon, coffee, tea, fat free broth, and clear
juices (only apple, grape, or cranberry). You
may also have jello, popsicles and carbonated drinks that are not RED in color.
You may drink water and clear liquids up until 5 hours before
your procedure. You should
have nothing by mouth after that.
At 6 pm (or 5 hours before bedtime), add 45
ml of Fleet Phospho-Soda to one-half glass of water (4 ounces) and drink.
This can be followed by one glass (8 ounces) of water or clear fruit
juice.
THE DAY OF THE PROCEDURE:
Five hours before your appointment, drink the second bottle of Fleet Phospho-Soda followed
by 3 glasses of clear liquid. If your
bowel movements do not become clear as liquid, please notify the nurses when you
check-in.