FLEXIBLE SIGMOIDOSCOPY 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 Health200 Fox Glen CourtBarrington, IL 60010 - Lower LevelLocated 1/2 mile west of Kelsey Rd. 847-382-7165
□ The Illinois Center for Digestive & Liver Health
5744 Broadway – 2nd Floor
Chicago, IL 60660
312-335-0180
□ Good Shepherd Hospital450 W. Highway 22Barrington, IL 60010847-842-4130 (call to pre-register)
□ Saint Joseph Hospital2900 N Lake Shore Drive10th FloorChicago, IL 60657 855-316-7700 (call to pre-register)
* 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.
*Purchase 2 Fleet Enemas at the pharmacy. You will need these the day of your procedure.
The day before your procedure
Start a liquid diet starting at 11am the morning before your procedure and continue until bedtime
Liquid Diet =Pudding, Yogurt, Ice Cream, Milkshakes, (Vanilla/Chocolate only), Clear Broth, Jell-O, Juice (no pulp), Tea, Sodas, Coffee. Please do not eat anything red in color.
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:DO NOT HAVE ANYTHING ELSE TO EAT OR DRINK(Including Gum and Hard Candy)
At this time, take your first enema and use it according to the directions on the box. Wait
1 hour and then give yourself the second enema.
IMPORTANT INFORMATION
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.
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.
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.
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.