DIGESTIVE HEALTH ASSOCIATES OF SOUTHWEST MI, PC DBA/Gastroenterology of Southwest Michigan
NAME:«Pt_Full_Name»
DATE: «Appt_Date»
ARRIVAL TIME: ______________________________
PROCEDURE: COLONOSCOPY You have an appointment with «Appt_Prov_Full_Name» at the Kalamazoo Endo Center.
The appointment time and date appear above. Please register at the KEC registration desk at your arrival time at 3300 Cooley Court. Please be sure to bring your Photo ID & Insurance cards. You will be asked for them when you check in. Should any problems arise and you may need to cancel your appointment, or have
any questions, please call our office at (269) 349-2266 during the hours of 8:00 a.m. to 5:00 p.m.
YOU MUST BE ACCOMPANIED BY A RESPONSIBLE ADULT TO DRIVE YOU HOME UPON DISCHARGE It is critical that you follow these written instructions as directed not the instructions on the prep box. Please stop eating all indigestible foods such as corn, seeds and popcorn at least 5 days prior to your procedure. A few days prior to your procedure please confirm that you have received a prescription for the 2 liters of HalfLytely. If you have not, please contact our office at 269-349-2266.
How to prep for your procedure:
1) Take TWO (2) Dulcolax tablets two nights before your procedure.
2) Start a clear liquid diet the morning before your procedure. 3) Drink 2 liters of Halflytely solution over two (2) hours starting at 6:00 P.M.
4) Have nothing by mouth after____________.
Because you will receive sedation for the procedure, you will need to avoid driving, drinking alcoholic beverages, operating machinery, using sharp instruments and
making critical decisions. Please bring a list of present medications and drug allergies. If you are allergic to latex products, please call our office as soon as possible so precautions The liquids listed below are allowed during the preparation. Consume nothing with red dye. Reminder: The more you drink the better your prep will be MEDICATIONS
Reduce the A.M. Dosage by ½ the morning of the procedure.
or other anticoagulants. STOP (5) five days prior to the procedure. Please contact our office for instructions 269-349-2266. STOP(7) Seven days prior to the procedure. Please contact our office for instructions 269-349-2266. DO NOT take day of the procedure. STOP(2) Two days before the procedure.
Take ½ the night before the procedure, and none the
**All other medications may be taken as directed** Concerning multiple bills in conjunction with your procedure: Please take note: When an outpatient procedure is performed at a facility you will receive billings from the facility AND the physician. ALSO, if pathology is done you will receive billings from Bronson or Borgess for handling the specimen AND from the pathologist for processing and reading.
Some insurance’s require pre-certification for inpatient and outpatient procedures. The procedure you are scheduled for is an outpatient procedure. Please check with your insurance carrier to determine if you need pre-certification. If you do not obtain pre-certification and your insurance requires it, the cost of this
procedure may become your financial responsibility. Thank you
CONFIDENTIAL INFORMATION: Surname: ____________________________ First Name: __________________________ Date of Birth: _________________________ Home Address: ____________________________________________________________ ____________________________________________________________ Postal Address: ____________________________________________________________ Home Ph: ____________________
Decade of Roma Inclusion 2005-2015 LOGISTICAL NOTE Employment Workshop Zagreb, Croatia June 15-16, 2009 Hotel ARCOTEL Allegra Branimirova 29 10 000 Zagreb VENUE OF THE MEETING The meeting will take place at hotel ARCOTEL Allegra, Branimirova 29, 10 000 Zagreb . Please note that the Croatian Government has made a block reservation of rooms in hot
DIGESTIVE HEALTH ASSOCIATES OF SOUTHWEST MI, PC