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Albanygi.com

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

Source: http://www.albanygi.com/Preps/EGD%20-%20BRAVO%20Prep.pdf