Albany Gastroenterology Consultants, PLLC YOUR PROCEDURE IS SCHEDULED AT: ____ ST. PETER¶S HOSPITAL - 315 South Manning Boulevard, Albany (Ground Floor [Past Elevator H], Endoscopy) ____ ALBANY MEMORIAL HOSPITAL - 600 Northern Boulevard, Albany (Main Entrance ± Outpatient Registration)
PATIENT NAME: __________________________________ PHYSICIAN: ____________________________________ Preparation Instructions: PROCEDURE DAY/DATE: _______________________________________ Upper Endoscopy (EGD) with BRAVO PROCEDURE TIME: ______________________________ ARRIVAL TIME: ________________________________ PREPARED BY: ___________________________________ Ext. ____________________________________________ *Please remember to arrange for a responsible adult to be with you during the procedure. If you do not have a responsible adult driver, your procedure will be cancelled and rescheduled. Review the preparation schedule below for the days preceding your EGD WITH BRAVO. *If you have a change in insurance prior to your procedure, you must notify the office immediately. If you need further assistance, please call (518) 438-4483.
1 Week Prior 1 Day Prior Procedure Day Last chance to Morning Procedures: Do not eat or drink anything after midnight the evening If you take medication, you may cancel your before your procedure. have it in the morning 2 hours appointment. prior to the procedure with a Afternoon Procedures: You may have CLEAR LIQUIDS up to 6 hours prior to small amount of water. Our office your procedure. requires a Arrive one hour before *****IF YOU ARE AN minimum of 48 Clear Liquid Suggestions: Water - Broth or bullion - Consomme ± Coffee/tea scheduled procedure time. INSULIN DEPENDENT hours notice
with NO milk - Gatorade - Soft Drinks - Juices without pulp - Clear Jell-O (no
DIABETIC, YOU MUST when canceling pudding) ± Popsicles/Italian Ice *NOTHING RED OR PURPLE* NO DRIVING ± you must have NOTIFY THIS OFFICE or rescheduling a responsible adult to assist you WHEN YOUR a procedure. MEDICATION PREPARATION: in getting home. You cannot PROCEDURE
___ You may take these medications before the test: drive. If you do not have a IS SCHEDULED.
ACIPHEX, NEXIUM, PREVACID, PRILOSEC,PROTONIX
responsible adult to assist you in getting home, the procedure will
___You may not take these medications ____days before the test: be canceled.
ACIPHEX, NEXIUM , PREVACID, PRILOSEC, PROTONIX
Let us know if you are on appointment: Coumadin, Plavix,
You must stop any Coumadin ____ days before the test. clopidogrel (generic Date to stop: _______________ Plavix) Lovenox or Pradaxa. ___Stop any antacids & Reglan 24 hours before the test. Date to stop: _______________ STOP taking these
____ No sleeping pills, sedatives, pain medications or muscle relaxers the night before
BIOPSY RESULTS: Please call
____You may take these medications before the test: AXID, PEPCID, TAGAMET, and
____You may not take these medications for _____ days before the test: YOU MUST BRING YOUR INSURANCE CARD(S) AND PHOTO IDENTIFICATION TO THE LOCATION OF YOUR PROCEDURE
A. D. COLEMAN 465 VAN DUZER STREET STATEN ISLAND, NEW YORK 10304-2029 USA T: (718) 447-3280 / F: (206) 350-1786 Email: [email protected] Web: http://nearbycafe.com CURRICULUM VITAE Full name: Allan Douglass Coleman Born: New York City, December 19, 1943 Educational background: Doctoral studies, New York University; Communications Theory, 1982-1990 M.A., S
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