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Please be
aware that if you do not prep as directed your procedure will
be cancelled.
THE MORNING OF THE PROCEDURE:
Do NOT Eat or Drink ANYTHING the Day of the Test,
EXCEPT:
1.) Your second dose of the bowel prep, or:
2.) Your morning medicines with a small sip of water
at least 4 hours before the exam. DO NOT CHEW GUM, HARD
CANDY, or SMOKE.
HMO insured patients may require a referral or
precertification.
You will need to bring your insurance cards, referral, and
co-pay at the time of the visit.
THE TEST
WILL BE CANCELLED IF:
1) You have no one to drive you home (A bus or taxi is not
acceptable),
2) IF you eat any food the day of the test,
3) IF you drink any fluids less than 4 hours before the test.
7 DAYS PRIOR TO YOUR EXAM:
Stop taking all aspirin and aspirin products (see attached
list). Tylenol is permitted before the test. Discontinue any
other medications only if directed by the office. Specific
Instructions for special situations such as diabetes are
given on the Medicine Instruction Sheet.
The WHOLE DAY BEFORE THE EXAM:
Clear Liquids ONLY for breakfast, lunch and dinner.
NO Solid Foods or Alcoholic Beverages.
NO red or purple colored drinks, please. You may have
Gatorade, Water Ice, Popsicles, Ginger Ale, 7-Up, Sprite,
Coke, Pepsi, or Any soda, Jello (yellow or green) and
chicken or beef broth. You may have black coffee and tea.
You may use sugar/sweetener.
Milk and cream are NOT allowed in the coffee or tea.
You may continue to drink clear liquids up until midnight of
the day before the colonoscopy.
The MORNING OF THE PROCEDURE:
Do NOT Eat or Drink ANYTHING the day of the test,
EXCEPT:
1.) Your second dose of the bowel prep, or
2.) Your morning medicines with a small sip of water
at least 4 hours before the exam.
DO NOT CHEW GUM, HARD CANDY, or SMOKE UNTIL AFTER YOUR
PROCEDURE.
If the test is scheduled after 1 PM then you may have small
sips of water up to 8 AM, then nothing more afterwards.
Your Procedure is scheduled on__________________at______am/pm
YOUR
PROCEDURE WILL BE CANCELLED IF YOU DO NOT FOLLOW THE PREP AS
ABOVE.
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MOVI PREP – SPLIT DOSING OPTION
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MoviPrep – You MUST Take TWO Doses:
FIRST DOSE - Please begin at the time checked below:
___ Begin after Work, but no later than 7 PM the night
before the colonoscopy.
Mix in the morning of the day you use the prep. Look at the
Illustration (below) on how to mix MoviPrep. After mixing
place in the refrigerator to make the MoviPrep cold. This
makes the MoviPrep taste better.
___ Or Begin the day before the colonoscopy at ____am/pm.
Mix the night before (as shown below) and place in the
refrigerator.
After finishing the first dose mix a fresh solution in the
same container and place in the refrigerator.
SECOND DOSE – Please begin as directed below:
THE SECOND DOSE MUST BE FINISHED 4 HOURS BEFORE ARRIVAL AT
THE CENTER FOR YOUR PROCEDURE
___ Begin the second dose the evening before the
colonoscopy at ___pm.
___ Begin the second dose the morning of the colonoscopy
starting by ___am
Note: Drinking with a straw decreases the ability
to taste the Moviprep, if the taste bothers you, and make
sure the Moviprep is cold.
The MORNING OF THE PROCEDURE:
Do NOT Eat or Drink ANYTHING the day of the test,
EXCEPT:
1.) Your second dose of the bowel prep, or
2.) Your morning medicines with a small sip of water at
least 4 hours before the exam.
DO NOT CHEW GUM, HARD CANDY, or SMOKE UNTIL AFTER YOUR
PROCEDURE.
If the test is scheduled after 1 PM then you may have
small sips of water up to 8 AM, then nothing more afterwards.
QUESTIONS
ABOUT THE PROCEDURE CALL 609-265-1700
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