Download MoviPrep - Illinois center for digestive and liver health

COLONOSCOPY PREPARATION
Patient Name _____________________
Date: ____________________________
Check in time: _____________________
Procedure time ____________________
For all procedures please allow up to
3hrs after arrival to be discharged.
Location:
□ The Illinois Center for Digestive & Liver Health
200 Fox Glen Court
Barrington, IL 60010 - Lower Level
Located 1/2 mile west of Kelsey Rd.
847-382-7165
* Please STOP taking Coumadin, Plavix,
Anti-Inflammatory medications and Aspirin
3-5 days prior to your procedure. Tylenol
(Acetaminophen) medications are okay.
* If you have had a heart valve replacement
please call our office for antibiotic
information.
* If you have had a total hip or knee
replacement within the last 6 months please
call our office for antibiotic information.
* Have your prescription for the colon
preparation filled at a pharmacy.
The day before your procedure
□ The Illinois Center for Digestive & Liver Health
5744 N Broadway – 2nd Floor
Chicago, IL 60660
Start a clear liquid diet starting at
11am the morning before your
procedure and continue until
bedtime
□ Good Shepherd Hospital
450 W. Highway 22
Barrington, IL 60010
847-842-4130 (call to pre-register)
Clear Liquids = Water, Juices (no pulp),
Tea, Carbonated Drinks, Black Coffee,
Gatorade, Clear Broths, Italian Ice & Jell-o.
NO Dairy products, NO Non-Dairy
Creamers and NO Red Liquids.
312-335-0180
□ Saint Joseph Hospital
2900 N Lake Shore Drive
10th Floor
Chicago, IL 60657
855-316-7700 (call to pre-register)
PLEASE FOLLOW ONLY THESE
INSTRUCTIONS
(not those on the prep medication package)
Step Two
Start the first dose of colon prep
between 4-6pm
MoviPrep - In the morning, mix 1 pouch A + 1
pouch B in the supplied disposable container
with lukewarm water up to the top line and
refrigerate for later. Begin drinking the first liter
of MoviPrep solution. The container is divided
by 4 marks so every 15 minutes drink the
solution down to the next mark. Then, drink
an additional 16 ounces of any clear liquid.
Mix the remaining pouch A + pouch B the same
way you did before with lukewarm water to the
top line and refrigerate for tomorrow morning.
The day of the procedure
Step One
5 HOURS before your procedure:
Take any morning medications EXCEPT
for Coumadin, Plavix, Aspirin,
Anti Inflammatory and oral diabetic
medications
Diabetics – If you are insulin dependent check
your blood sugar. If it is over 200 please take
HALF of your insulin dose. If you are on oral
medications please do not take any of those
medications but please bring them with you
when you come in for your procedure.
Step Two
4 HOURS before your procedure:
Start second dose of colon prep
(follow the same steps as the night before)
Step Three
2.5 HOURS before your procedure:
DO NOT HAVE ANYTHING
ELSE TO EAT OR DRINK
(Including Gum and Hard Candy)
It is VERY important as it will delay your
procedure time and could possibly result in
having your procedure rescheduled.
IMPORTANT INFORMATION
About your colonoscopy
You MUST have a ride home. The
driver must be at least 18 years old.
Your ride must present themself
prior to discharge. Absolutely no
cabs or walking allowed.
A colonoscopy is a procedure that allows the
physician to evaluate the lining of the colon for
abnormalities by inserting a flexible lighted tube
from the anus to the beginning of the colon. This
procedure requires adequate and thorough
cleansing of the colon before the examination can
be performed. You should have received a
prescription for one of the preparations.
You will develop diarrhea while taking the medicine
for colon cleaning. Don’t be alarmed, this is
normal. Abdominal cramps and nausea are
common side effects. If you do not experience any
diarrhea after completing the preparation please call
the office and have the doctor paged immediately.
Have your insurance card, picture ID
and copayment ready at time of
service.
Women of childbearing age will need
to take a pregnancy test before the
procedure.
Go to our website to start your
paperwork (foxglengi.com) and
bring the printouts along with you on
the day of your procedure if possible.
Biopsy results can sometimes take
up to 10 days. Please call our office if
you have not heard from us after this
time period.
Cancellations/No Shows less than 24
prior to your procedure are subject to
a penalty fee of $125.00.
It is important that you notify us if you have
had recent hip or knee surgery or if you need
antibiotics before the procedure. Please notify
our office when checking in for your procedure or
call ahead of time.
A colonoscopy is a well-tolerated procedure. You
will receive medication through a vein to help you
relax and increase the tolerance of any discomfort
from the procedure. You will be lying on your side
or back during the procedure. The examination
takes between 30-45 minutes. You will be here
approximately 3 hours from the time you check
in to the time you leave. Your ride does not have
to stay with us the entire time. They can leave their
phone number and we will call them when you are
ready to be picked up. Someone must drive you
home.
If some abnormality is detected, in the course of
examination, biopsy and/or removal of polyp(s) it
will be carried out during the same session.
Remember, biopsies are done for various reasons
and do not mean that cancer is suspected. Polyps
are abnormal growth in the colon lining. These vary
in size from a tiny dot to several inches. The
majority of these polyps are non-cancerous.
However the appearance of a polyp does not tell its
nature, it is therefore sent to a pathologist for tissue
analysis. The results of the biopsy sometimes
take up to 10 days. Please call our office if you
have not heard from us after this time period.
You may have some cramping or bloating during or
after the examination. This generally disappears
after passage of gas. You are able to eat your usual
diet after the procedure unless some unusual
finding suggest otherwise, you will be advised if
there are any restrictions.
Although complications after colonoscopy are
uncommon, it is important for you to be aware of
the possibility. Bleeding from the biopsy site or
polypectomy may occur. It is usually minor and
stops on its own. Localized irritation of the vein
where medications were injected may cause a tender
lump lasting at times for several days, this will go
away eventually. Applying hot packs or hot moist
towels may help relieve discomfort.
Insurance Information
We are in network with most major insurance
carriers. This procedure is covered by most
insurance companies but it is the patient’s
responsibility to check with your insurance carrier if
a pre-certification is needed. Insurance carriers will
impose a penalty if pre-certification is not obtained.
Our office will assist as much as we can however,
pre-certification is your responsibility. If you have
an HMO it is also your responsibility to make sure
that you have a referral that will cover this
procedure before you come to the office. You will
receive a statement from our business office
regarding charges, payments, and balance due.
Depending on your insurance coverage, you may be
required to pay your co-payment and co-insurance
amount at the time of service.