Doctorgi.net

GASTROENTEROLOGY ASSOCIATES, PC
Preparation Instructions For Colonoscopy with Movi-Prep
At Prince William Hospital
Appointment Date: __________________________ Appointment Time: ___________________________
• PLEASE BE SURE TO FOLLOW INSTRUCTIONS THE DAY BEFORE PROCEDURE Date: _____________ CAREFULLY. IF NOT WELL PREPPED, THE PROCEDURE MAY BE CANCELLED AND • When you wake up, first mix Pouch A and Pouch B into the disposable container. Add lukewarm water to the top • The Hospital will be calling you prior to your line of the container. Shake and refrigerate. (Follow our appointment to do a pre-op assessment over the phone. instructions, not those printed on the Movi-Prep box) • You will be medicated for this procedure so you
• Start a strict, clear liquid diet. – NO SOLIDS! No
must have a friend or family member drive you
dairy or dairy products. A clear liquid diet can include:
home. They must stay during procedure and
Water, sparkling water, apple juice, white grape juice, recovery time.
iced tea, hot tea, Gatorade, sodas-any kind, black coffee • You will not be allowed to drive or ride in a cab! If
(no cream or milk), broth/bouillon, Jell-O, popsicles. (No someone does not accompany you, you will be
red, purple or orange dye in anything you drink.) cancelled and rescheduled for another day.
• If your appointment is after 12:00 PM, you may have If you take Coumadin, please call our office for
solids until ____________. Then you may have only CLEAR LIQUIDS, as noted above, for the rest of the day. Please check with your insurance company to ensure coverage and that you have met all referral • Drink at least 8-10 glasses of clear liquids today. • At __________ start drinking the refrigerated mix. Every 15 minutes, drink the solution down to the next mark on 7 days before the procedure Date: ________________
the container until the liter is complete. • STOP foods with Olestra (usually found in fat-free • Mix second Pouch A and Pouch B into container with lukewarm water and refrigerate until tomorrow morning. • Arrange a ride home, if not already done. 5 days before the procedure Date: _________________
THE DAY OF PROCEDURE Date: ______________ • STOP eating foods with seeds, nuts and whole grains. • STOP eating corn and popcorn. • At __________ start drinking the refrigerated mix. Every • Do not take Iron supplements, Vitamin E or Fish oil 15 minutes, drink the solution down to the next mark on (Omega 3/ Flax seed oil/ Cod liver oil). the container until the liter is complete. • After you have completed the second container of solution, DO NOT EAT OR DRINK ANYTHING,
3 days before the procedure Date: _________________
INCLUDING WATER, UNTIL YOUR PROCEDURE
• STOP Aspirin and anti-inflammatory medications IS DONE. (Also, no chewing gum, no candy and no
(Aleve, Advil, Motrin, Ibuprofen, NSAIDS, Naproxen, Excedrin, Bufferin, Plavix, Celebrex, etc). If you take blood pressure or anxiety medicines, you may Please arrive at the Hospital at: _________________
If you need to cancel your appointment, call our office • Someone should stay with you for 24 hours. Review the diet you need to follow for the next 2 days. ABSOLUTELY NOTHING to eat or drink, including water, for the 6 hours before your procedure.
(This also includes NO c
hewing gum and NO candy.)
If you have any questions, call (703) 368-6819.

Source: http://www.doctorgi.net/docs/MoviPWH.pdf