Looking for a Medical Checklist Templates? Download it for free!

CENTER FOR GASTROINTESTINAL DISORDERS, Inc.

S. Saeed Zamani, M.D.

Phone: (925) 939 5599

Colonoscopy Preparation Instructions

You are scheduled to have a colonoscopy on_____________at____________________.

Please report to the above facility Registration Department at ___________________.

Colonoscopy is a procedure to examine colon (large intestine) with a flexible instrument.

Please follow these instructions to prepare for the procedure. Please be aware that if

your bowel is not clean, we may have to reschedule your procedure.

How do I prepare for the colonoscopy?

DO NOT take ASPIRIN, PLAVIX, AGGRENOX, or IRON

days before the colonoscopy

DO NOT take COUMADIN. Please inform us if you have an artificial

days before the colonoscopy

heart valve or history of endocarditis

DO NOT take MOTRIN, ADVIL, IBUPROFEN, ALEVE, or

days before the colonoscopy

NAPROXEN or CELEBREX. Diabetic patients’ insulin or oral

medications to be adjusted as per instructions.

The day BEFORE the

All day, take only CLEAR LIQUIDS, e.g. clear broth, water, tea, black

examination

coffee, apple juice, white grape juice, any soda, ice popsicles, strained

lemonade, Gatorade, Jell-O (avoid red or green Jell-O). No solid food,

milk, milk products, or Ensure.

Start taking OSMOPREP tablets at 4 pm or sooner as instructed on

reverse side of this sheet. It is important to take 1 glass of water (8 Oz)

with each dose. Bowel movements usually occur approximately 30-60

minutes after the first dose and will continue for 1-2 hours after you

finish the last dose. Please maintain hydration by drinking adequate

liquids.

Do not eat or drink after MIDNIGHT (Except your medications and

OSMOPREP tablets with water).

The day of examination

Take your medications especially blood pressure and heart medicines

(except as above) with sips of water.

You MUST have somebody drive you home because you will be sedated

or your procedure will be cancelled. You cannot go home in a Cab. Do

not drive or operate any machines the day of the procedure.

What happens during the procedure?

○ A nurse or doctor will give you medicine to relax you and make you sleepy.

○ Your doctor will put air into the colon and this may feel like “gas pain”.

○ Your doctor may take a biopsy or remove a polyp. This does not cause pain.

What happens after the procedure?

You will be taken to a “Recovery” room where you will remain until you are awake. If you need to cancel,

please call our office at least 3 days before the procedure. Charge for cancellation of a scheduled procedure

if not cancelled 3 days prior to procedure is at least $200. We understand that emergency situations are out

of your control. Please contact us if you have any questions about the procedure or the preparation.

112 La Casa Via, Suite 320 Walnut Creek, CA 94598

Phone: (925) 939 5599

Fax: (925) 939 4099

Colonoscopy Preparation Checklist Template - Center For Gastrointestinal Disorders, Inc.

Related Articles

Related forms

Related Categories