Gastroenterology, pa

Gastroenterology, PA
Gatorade miralax prep
Colon Prep Instructions
At any pharmacy over the counter, purchase 1 bottle
of Miralax(238gm) and 4 Bisacodyl(Dulcolax) tablets
The day before your procedure
Date:___________________________________
1. Start a clear liquid diet 24 hours before your procedure. No solid food until after your colonoscopy. 2. Drink at least 8 oz. (1 large glass) of clear liquids every Please follow the attached instructions
hour starting at 10:00 AM until you go to bed.
Exactly as directed to ensure a
Safe and effective prep.
3. At 1:00PM Take 2 Bisacdoyl Laxative Tablets
Follow these instructions rather than any

4. At 5:00 PM Mix Miralax 238gm bottle with 64oz of
included with your purchased prep kit.
Gatorade (not red, blue, or purple). Drink an 8oz glass every 10-20 minutes until solution is gone. (*You may Colonoscopy is 95% successful in detecting cancerous mix solution one hour before and chil in refrigerator) and precancerous abnormalities in the colon. It is the best available test, but it is not foolproof. 5. At 9:00PM Take 2 Bisacodyl tablets with clear liquids
The cleaner your colon is prior to your exam, the more likely we are to locate any abnormalities. The timing of this dose is important and
should not be altered.
Like any invasive exam, colonoscopy has a number of potential risks, including bleeding that may require transfusion, a tear that my require surgery, kidney Nothing further by mouth with the exception of
damage related to your preparation, reactions to any medications that must be continued. Medications
medicines used to sedate you, and an inability to detect may be taken with small sips of water.
potentially serious abnormalities. These risks are small. Colonoscopy is generally a safe procedure. We believe on ____________ arrive at _____AM
at ___________________ Hospital
After your colonoscopy
Drink at least 6 more 8 oz. glasses of clear
It is very important that you remain well-hydrated for a
liquid prior to bedtime.
number of days prior to and after the procedure

Frisbie Memorial Hospital Patients: Frisbie wil contact you to
pre-register and wil cal the day before your procedure with Please note the following:
Portsmouth Regional Hospital Patients:
 You will need a ride home from the hospital.
Please cal (603) 433-5223 from 8:00 AM–4:00 PM, Mon.-Fri. to Hospital policy requires transportation must be provided by a responsible person after your procedure. Wentworth Douglass Hospital Patients: Wentworth will contact
Failure to comply may result in cancel ation of procedure
you to pre-register and our of ice wil cal the day before your procedure with your procedural time.  No driving or operating machinery until the day
York Hospital Patients
: York will contact you to pre-register and
will call two days before with your procedural time  3 days prior to your exam, avoid corn, popcorn,
foods with seeds, nuts, and raw vegetables.
.THE PURPOSE OF THIS PREP IS
TO CLEAN OUT YOUR COLON
PRIOR TO PROCEDURE
Additional Instruction for
Patients with Diabetes
Al efforts wil be made to schedule your case in (Do not eat or drink anything with
the early morning. If not, consult your physician Red, Orange or Purple coloring or
drink any Alcohol)
The clear liquid diet contains foods with sugar. Continue your blood sugar testing before your procedure; perform a test at home before leaving for your procedure and report the result to the nurse upon your ar ival at the hospital. If you are taking tablets that contain Metformin (Glucophage, Avandamet, Metaglip, Glucovance or generic forms of Metformin), discontinue the day before your procedure and resume the day Other tablets for diabetes (including Glyburide, Glipizide, Actos, Avandia, Prandin, Starlix, Glyset, Precose) may be taken on the day and night before your procedure, but not on the morning of your procedure. Resume the tablets If you are taking long acting insulin (Lantus), do not stop it. If your long acting insulin is NPH, Lente or Ultralente, take your normal dose the evening before, but only 2/3 your usual dose on Reminder: It is very important that you
remain hydrated for a number of days
If you are taking a rapid acting Insulin (Regular, before and after your procedure
Humalog, or Novolog) do not take any on the morning of your procedure, unless your blood sugar is above 200 mg/dL in which case you If your blood sugar is high before, during or after the procedure, you may receive extra shots of Gatorade® or sports drinks
will result in better hydration
instead of drinking just
If you have any questions, please contact your
water alone.
primary care physician or diabetes physician.
Screening /Diagnostic
GASTROENTEROLOGY
Colonoscopy Disclaimer
Professional Association
Estimated price range of colon procedure(s):
$ 695.00 - $ 1450.00
Please note that the estimate above applies to physician’s charges from David P. Flavin, MD
Robert A. Ruben, MD
Roger M. Epstein, MD
We are unable to quote and do not have cost estimates for
hospital, pathology, lab or radiology services.
William E. Maher, MD
Aristotle J. Damianos, MD
A screening colonoscopy is recommended to identify
Jaime A. Baquero, MD
pre-cancer or cancer in people without symptoms who
have reached a certain age. The American Medical
Society recommends a screening/routine colonoscopy
for all individuals beginning at age 50 years old. If you
have a family history of some types of digestive
disorders, your primary care physician may refer you
before the age of 50 years old for a screening/routine
procedure.
A screening/routine procedure is a recommendation
only. You are scheduling this procedure to determine
whether or not you have a medical condition that may
warrant further study.
If anything is found requiring ‘action’ during your
screening test, it will be coded as a diagnostic test. A
diagnostic test may not be covered the same as a
screening test under the terms of your specific
insurance policy.
Some health insurance benefit plans cover
screening/routine procedures at 100% of their cost
while diagnostic procedures/tests are subjected to a
co-insurance and/or a deductible contribution(s) each
calendar year from the patient.
While physicians and staff of Gastroenterology PA are
aware insurance benefits may differ depending on the
outcome of your test, they are unable to predict if your
test will be coded as a screening exam or diagnostic
test before the procedure.
We recommend you contact your insurance company
to determine what if any financial responsibilities you
may incur from your health insurance plan prior to your
procedure.

I am aware that my insurance plan may contain contract language
that wil deny and/or change the terms of benefit(s) for the
service(s) and reason(s) as described above. I understand if my
insurance plan does not cover all or covers only a portion of the
charges submitted on behalf of Gastroenterology, PA, that I have
agreed to be personally and ful y responsible for all payment
balances due as outlined in the Waiver of Liability previously signed
by me. I also recognize that as the policyholder of the insurance
plan, I am able to submit a written appeal directly to my insurance
company to request a reconsideration of benefit payment.
For all insurance plans except Medicare

Source: http://www.gaspa.com/wp-content/uploads/2010/07/gatorage-miralax-prep.pdf