Download 2 day Miralax Split Prepopik

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Your Physician is: Dr. Kim
Procedure Date:__________________________________ Arrival Time:_________________
Your Procedure is scheduled at:
Ministry Saint Michael’s Hospital – Check in at 1st Floor HUB
900 Illinois Avenue
Stevens Point, WI 54481
Phone: 715-346-5431
One Week Prior to Procedure:
DO NOT take Aspirin, Ibuprofen, Advil, Aleve, Nuprin, Motrin, Naproxen or Orudis
DO NOT eat nuts, seeds, popcorn or corn
3 Days Prior to Procedure:
Stop taking Iron and vitamins with iron
Stop taking fiber supplements (Metamucil, Citrucel, Fiberall, etc.)
Over the Counter Purchases for your Procedure:
1 box Dulcolax 5mg laxative tablets (you will only need to take 4)
238 gm / 8.3 oz bottle of Miralax
Prepopik prescription called into your local pharmacy – __________________________
64 oz Gatorade (not red or purple), water or low sugar clear liquid
2 Days Prior to Procedure:
Immediately upon waking up in the morning start a clear liquid diet. Examples of clear
liquids include clear juices (apple or white grape), black coffee (no cream), tea, soda, sports
drinks like Gatorade or PowerAde, lemonade, broth, jello, popsicles and of course water. Do
not drink anything red or purple. It is important that you drink as much fluid as you can
throughout the day.
At 3 p.m. take the 4 Dulcolax laxative tablets with 8 oz glass of water
At 5 p.m. mix the Miralax with your 64 oz of clear liquid. Drink a glass every 10-15 minutes
until it is gone
Day Prior to Procedure:
Continue on a clear liquid diet all day. It is important to stay hydrated so try to drink as much
fluids as possible throughout the day.
At 5 p.m. dissolve one packet of Prepopik in 5 oz of clear liquid and consume, followed by
five 8 oz glasses of clear liquid
Continue to drink clear liquids until Midnight, this will help flush out your system.
Day of Procedure:
At 6 a.m. dissolve second packet of Prepopik in 5 oz of clear liquid and consume, followed by
three 8 oz glasses of clear liquid. Then nothing to eat or drink until procedure is completed.
You may take your medications with a small sip of water unless otherwise instructed
You can plan on being here approximately 2 hours. You must be accompanied by a friend or relative
to drive you home. You MAY NOT drive, walk or ride a bike home. If you do not have a
responsible driver, your procedure may be cancelled.
Bring a list of the medications (including the dosages) that you take.
Bring a list of allergies to medications that you have.
If you have any questions or concerns regarding your procedure, please call 715-346-5431. After
hours call 715-346-5000 and ask for GI Nurse on call for Ministry Saint Michael’s Hospital.
Special Instructions:_______________________________________________________________
If you need to reschedule or cancel your procedure, please call 715-346-5431 from 8 a.m. – 5 p.m.
Many insurance companies have pre-certification requirements for procedures. Insurance carriers
and Medicare may have restrictions on their coverage depending on whether it is a diagnostic (done
to determine what is causing a medical problem) or screening (done to detect a medical condition
before you have symptoms). Call your insurance company to check your benefits BEFORE your
scheduled appointment.