Cln Hydrtherapy Prep PROCEDURE DATE: COLON CLEANSE APPOINTMENT TIME: ***After yu finish with yur cln cleanse yu will g directly t Summit Endscpy Center (Suite C) *** IF YOU HAVE A BOWEL MOVEMENT 3 OR LESS IN A WEEK, PLEASE LET YOUR NURSE KNOW. COST: The cst f the cln cleanse is $69.00. This amunt is nt cvered by any insurance plan. This can be paid by cash, check r credit card. The fee must be paid separate frm any deductible yu may be required t pay. Checks shuld be made payable t ADVANCED MEDISPA. There will be a $20.00 nn-refundable fee upn scheduling this appintment. The remaining $49.00 will paid n the service date. This cannt be billed t yur accunt. WHAT YOU WILL NEED: 6 Dulclax Tablets (bisacdyl) 3 Packets f Miralax Pwder T ensure that Dr. Nuak gets the best view pssible yu MUST fllw the instructins n the back f this page.
PREPARING FOR YOUR PROCEDURE 2 DAYS BEFORE YOUR TEST: DO THIS ON: Avid any fds with seeds, nuts, uncked vegetables, r red dye. A light diet is best. Als, yu MUST drink plenty f water all day, this will help achieve the best results pssible. At 6:00 p.m., take 2 Dulclax (bisacdyl) tablets. YOU CANNOT MISS THIS! THE DAY BEFORE YOUR PROCEDURE: DO THIS ON: YOU MUST BE ON A CLEAR LIQUID DIET THIS ENTIRE DAY!! THIS IS VERY IMPORTANT (SEE CLEAR LIQUID DIET) The mre liquids yu take in, the better yur preparatin will wrk. At 4:00 p.m., take 4 Dulclax (bisacdyl) tablets. YOU CANNOT MISS THIS! At 6:00 p.m., mix three (3) packages f Miralax Pwder with 12 unces f water, cffee, r tea. If yu have nt had a bwel mvement by 8:00 p.m., yu will need t drink ne 10z bttle f magnesium Citrate. DO NOT EAT OR DRINK ANYTHING AFTER MIDNIGHT!! THE DAY OF YOUR PROCEDURE: DATE: D nt eat r drink anything until after yu cmplete yur prcedure. G t Advanced MediSpa t cmplete yur cln preparatin at yur appinted time. If yu have ANY questins r cncerns, please call the ffice at (731) 884-0600 and ask t speak t a nurse. They will be happy t assist yu. Cancellatins MUST be made at least three (3) days in advance. Tw (2) hurs r mre have been set aside especially fr yu. We must have plenty f advance ntice if yu plan t cancel s smene else can be bked in yur place.
CLEAR LIQUID DIET This diet is t be fllwed fr ne (1) day prir t yur prcedure. What is safe t eat r drink? Water Ice Tea (sweet r unsweet) Cffee (NO milk r creamer) Clear Builln (chicken r beef) Cnsmme Brth (chicken r beef) Apple Juice Grape Juice Jell (NO RED r any flavrs cntaining RED DYE) Carbnated Beverages (Lighter flavrs are preferred) Lemnade (use mix nly NO fresh squeezed r thse cntaining pulp) Ppsicles (NO RED, NO PUDDING POPS, NONE with fruit pieces) Gatrade (this is excellent fr yu because it cntains electrlytes that will keep yu frm feeling s weak.) Hard Candy (suck n candy, DO NOT chew it) THINGS YOU SHOULD NOT HAVE: MILK ORANGE JUICE ANYTHING CONTAINING PULP If this diet is nt fllwed cmpletely during specified times alng with the cln preparatin that yu chse yu will NOT achieve the desired results and culd pssibly have t reschedule yur prcedure.
1109 E. Reelft Ave., Suites B-C Unin City, TN 38261 Phne: (731) 884-0600 Fax: (731) 885-3692 Kfi Nuak, M.D. Gastrenterlgist IMPORTANT INSTRUCTIONS Yu MUST bring a driver; smene MUST stay in the center while the test is being perfrmed. This is in case the physician needs t speak with smene urgently. DIET: YOU MUST NOT EAT OR DRINK ANYTHING AFTER MIDNIGHT! Unless therwise specified. NO hard candy, gum, r chewing tbacc the mrning f yur prcedure. Fr the privacy f all patients, we ask NO children be in the pre and pst perative area. Please turn ff cell phne when entering the pre and pst perative area. NO jewelry t be wrn n the day f prcedure.. We are NOT respnsible fr any lst r stlen items. YOU WILL NOT BE ABLE TO DRIVE, WORK, OR OPERATE HEAVY MACHINERY FOR 12 HOURS AFTER PROCEDURE. THINGS TO BRING ON THE DAY OF YOUR PROCEDURE: Any Inhalers Wear Scks Extra clthing It is ur aim at Summit Endscpy Center t prvide efficient, persnalized care t yu. We have therefre reserved a specific time fr yur prcedure. If yu decide t cancel yur test, we ask that yu infrm us 3 days in advance s that we can reschedule yur test. This helps us t better care fr all f ur patients and deal with any insurance issues.