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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: ____________________________________
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
Last chance to
Morning Procedures: Do not eat or drink anything after midnight the evening
If you take medication, you may
before your procedure.
have it in the morning 2 hours
prior to the procedure with a
Afternoon Procedures: You may have CLEAR LIQUIDS up to 6 hours prior to
small amount of water.
Arrive one hour before
*****IF YOU ARE AN
minimum of 48
Clear Liquid Suggestions:
Water - Broth or bullion - Consomme ± Coffee/tea
scheduled procedure time.
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
a responsible adult to assist you
in getting home. You cannot
___ You may
take these medications before the test:
drive. If you do not have a
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:
ACIPHEX, NEXIUM , PREVACID, PRILOSEC, PROTONIX
Let us know if you are on
You must stop
any Coumadin ____ days before
Date to stop: _______________
Plavix) Lovenox or
any antacids & Reglan 24 hours
before the test.
Date to stop: _______________
____ No sleeping pills, sedatives, pain medications or muscle relaxers the night before
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@example.com 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
July 2013 Advising on this article: M. Lynn Crismon July 5, 2013 Should FDA backpedal on citalopram warning? New study shows higher doses not associated with arrhythmia, death Key Point Citalopram (Celexa—Forest; various generics) doses greater than 40 mg daily were not associated with increased riskof ventricular arrhythmia or all-cause, cardiac, or noncardiac mortality as compare