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TRI-CITIES DIGESTIVE HEALTH CENTER, P.S.
8819 W. Victoria Ave. Kennewick, WA 99336 (509) 460-5500
www.checkmycolon.com

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Colonoscopy is a detailed internal visual examination of the entire colon using a flexible scope. A sedative will be given to reduce the discomfort and pressure usually experienced with this exam. YOU WILL NOT BE ABLE TO DRIVE FOR THE REMAINDER OF THE DAY. It is REQUIRED that you have someone to drive you home. It is also REQUIRED that your driver check in with you when you come for your procedure, and stay in our office while you are here for your procedure. Plan on being here for 1 to 1 ½ hours.

Do not plan any out of town trips for one week after your colonoscopy. If the doctor finds polyps he may remove them (polypectomy). It is important to remain close to home in the event of side effects or complications from this, such as bleeding.

TWO DAYS BEFORE COLONOSCOPY: Date _______________

1. Low-residue diet: no fruits, vegetables, nuts or fibrous grains. No fiber supplements (i.e.: Metamucil, Citrucel, Benefiber, etc…)

ONE DAY BEFORE COLONOSCOPY: Date _______________

1. Clear liquid diet ONLY. Clear liquids include: Jell-O, soft drinks, broth, coffee, tea, fruit juice (pulp free), Gatorade and popsicles. No dairy products. PLEASE DO NOT HAVE ANY RED LIQUID OR JELLO, as these may be mistaken for blood by your physician. Remain on clear liquids only the entire day, with no restriction on the amount of liquid taken in.
2. At 12:00 pm take 2 (two) Dulcolax/Bisacodyl tablets.
3. At 5:00 pm, start drinking from the 4 liter container containing the laxative. You will drink 1 cup of this liquid every 10 minutes until you have consumed 12 cups . It is important to the success of the exam that the colon be properly prepared. You may continue with a clear liquid diet after finishing the laxative solution. Remain close to toilet facilities, as it is expected that the laxative solution will work quickly .

EXAM DAY

1. 4 hours prior to appointment time , at _______________ drink the remaining 4 cups of laxative liquid, 1cup every 10 minutes, just as was done the night prior.
2. Necessary medications may be taken with a sip of water at least 3 hours before the exam. Nothing else may be taken to eat or drink after the remainder of the above bowel prep.
3. Wear comfortable loose-fitting clothing to the exam.

PICK UP FROM PHARMACY OF YOUR CHOICE: (2) Dulcolax tablets, (1) 4 liter container of Colyte, Gavilyte, or Nu-lytely (requires a prescription)

APPOINTMENT DATE: __________________ ARRIVAL TIME*: __________________

*Please note: Your appointment time indicates the time you need to be at the office for preparation. It does not indicate the time the procedure will start. YOU WILL RECEIVE CONSCIOUS SEDATION DURING YOUR COLONOSCOPY. IT WILL NOT BE SAFE, OR LEGAL, FOR YOU TO DRIVE AFTERWARDS. IT IS REQUIRED THAT YOU HAVE SOMEONE TO DRIVE YOU HOME. IF YOU DO NOT HAVE A DRIVER WITH YOU WHEN YOU COME FOR YOUR PROCEDURE, WE WILL CANCEL YOUR PROCEDURE.

IF YOU ARE UNABLE TO KEEP THIS APPOINTMENT, PLEASE GIVE OUR OFFICE 48 HOURS ADVANCE NOTICE TO ALLOW FOR SOMEONE ELSE, WHO MAY BE WAITING AND IN NEED OF A PROCEDURE, TIME TO USE THIS ALLOTTED APPOINTMENT SLOT. THANK YOU.
Rev. 01/2014

Mid-Columbia Endoscopy Center is a modern, up-to-date freestanding Ambulatory Endoscopy Center, with state of the art equipment for the performance of endoscopic procedures. This facility was built in accordance with Medicare specifications and is Medicare certified. The facility provides an alternative to performing these procedures in a hospital outpatient setting. Running our own facility allows our medical team to closely monitor quality control. Long delays in scheduling and prolonged waiting periods are avoided. Thus we are able to provide our patients with prompt, efficient, and convenient service, in a comfortable setting, at a greatly reduced cost.

Before you have your scheduled procedure done, we recommend and encourage you to contact your insurance carrier to verify that you have coverage available for the procedure scheduled. When you receive your bill you will note that there are two charges for your procedure . The first charge is for the doctor's services. The second charge is the facility fee , which covers the cost of running the facility, the purchase and maintenance of the endoscopes and other equipment, nursing services, IV conscious sedation, and disposable items used during the procedure. The facility fee is in lieu of the bill you would otherwise receive from the hospital if the procedure were done there. Medicare and most other insurance carriers accept and will pay the facility charge. The advantage of this format is that the cost of the facility fee that accompanies the procedure is considerably less than it would be when performed in a hospital setting, providing you and your insurance carrier with a substantial cost saving. If you have any questions regarding the facility fee or filing your insurance, our bookkeeper will be glad to assist you. If you would like to tour the facility before your procedure, just ask the nurse.

There may be additional charges associated with your procedure. If biopsies are taken or polyps removed during your procedure, they will be sent to a pathologist for examination and diagnosis. You will receive a bill from them for those services , and any questions regarding that bill should be directed to the phone number listed on their billing statement.

If you receive anesthesia for your procedure, you will receive a bill from the anesthesiologist for their services . Questions regarding a bill from the anesthesiologist should be directed to the phone number on their billing statement.