YOU HAVE BEEN SCHEDULED FOR A FLEXIBLE SIGMOIDOSCOPY
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 flexible sigmoidoscopy. 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.
Avoid eating nuts, seeds, grapes, beans, green peas, salads, 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.
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.
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:
Four hours before your appointment (the day of the
procedure) 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.