The Whitman Building, 8380 Riverwalk Park Blvd., Suite 200, Fort Myers, FL 33919
Telephone (239) 561-7337 Fax (239) 561-0244
Evelyn R. Kessel, M.D. Brent M. Myers, M.D. Irma Cruz, M.D
Date and time of your procedure:_______________________ Arrive at:_____________________ Location:
⃞ Riverwalk Endoscopy Center
8380 Riverwalk Park Blvd #220, Fort Myers FL 33906. (239) 454-7544
⃞ Health Park Medical Center
9981 S Healthpark Dr, Fort Myers, FL 33908 (239) 432-3291
Out patient registration MIRALAX Preparation for Colonoscopy You are scheduled to undergo a colonoscopy. In order for the examination to be successful, your colon must be completely clear of stool. For this reason you must take a laxative the day before the procedure. Please follow these instructions carefully. If your colon is not completely clear it may interfere with the ability to evaluate your colon and could even require that the test be repeated. If you have any questions contact us at (239) 561-7337 or call the facility at which your procedure is being performed. Purchase at your pharmacy:
One Bottle of Miralax Powder 238 grams (you do not need prescription)
Four Dulcolax tablets or Bisacodyl (you do not need a prescription)
One 64 oz bottle of Gatorade (any flavor except red or purple) OR 64 oz of Crystal Light (any flavor except red or purple) (If you have diabetes) THE DAY BEFORE YOUR PROCEDURE
SOLID FOOD IS NOT ALLOWED Drink only Clear Liquids: ANY LIQUID THAT YOU CAN SEE THROUGH AND HAS NO PULP IS ACCEPTABLE Soups: Clear bouillon, Chicken broth, vegetable broth, beef broth. Beverages: Water, Tea, Coffee (without cream or milk), Kool-Aid, carbonated beverages, Gatorade. You may add sugar to coffee and tea, but not milk or creamers. Juices: White cranberry, apple, white grape, strained lemonade. Dessert: Italian ices, Popsicles, Jell-O (lemon, pineapple, white grape etc…) and hard candy. Any flavor except red or purple LIQUIDS NOT ALLOWED: Alcoholic beverages, milk, Red, purple liquids or red Jell-O
It is very important to increase your fluid intake to prevent dehydration, please make sure to drink at least 8 glasses (2 quarts) or more of fluids such as Gatorade or a similar product, preferably not just plain water.
At 3:00 pm Mix the 238gr bottle of Miralax in 64 oz of Gatorade or Crystal Light.
Drink 8 oz every 15 minutes until finished.
You may continue to have clear liquids until midnight.
Take all your medications unless otherwise specified.
ON THE DAY OF YOUR COLONOSCOPY
Continue with all your usual prescription medications unless otherwise specified. If you have Asthma bring your inhalers as well as a complete list of all medications you take along with the dosages, insurance cards and your glasses.
After your procedure is done your designated driver will take you home where you can eat and relax the rest of the day. You must have a driver to take you home (not a taxi). SPECIAL INSTRUCTIONS: ________________________________________________________________________________________________
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