Clear Liquid Diet Instructions

Purpose: To provide clear liquids which leave no residue in the intestinal tract and provide fluids.

Rationale: This diet provides clear (non-residue) fluids when acute illness produces intolerance to solid foods, in pre- and post- surgical situations, IN TIMES WHEN IT IS NECESSARY TO LIMIT RESIDUE IN THE COLON, and in preparation for some radiological studies. The diet consists mainly of foods which are clear and liquid at room temperature.

Allowed Foods (food you may have):

• Coffee (No milk or cream of any kind)
• Decaffeinated coffee (No milk or cream of any kind)
• Plain ice tea or hot tea (NOT  red in color)
• Carbonated beverages (NOT red in color)
• Water

• Plain gelatin (NOT red in color)
• Popsicles and Fruit Ice (NOT red in color)

Clear juices without pulp are allowed

• Apple, grape lemonade, Gatorade (NOT red in color)

• Clear broths only

• Sugar, Honey, sugar substitutes are allowed when indicated.

Other allowed items:

• Salt and Salt substitute when indicated
• Clear hard candy as tolerated

1. DO NOT eat or drink anything after midnight the night before your exam. (You may eat and drink UP TO, but NOT AFTER midnight.)
2. DO NOT take any medicine before the procedure (the morning of). If you are on heart medicine or high blood pressure medicine, bring your medicine with you to the facility.
3. If you are unclear about these prep instructions and it is after office hours the night before your exam, call the office and our answering service will contact the doctor on call.
4. Do not wear contact lenses to the procedure. You may bring a case with your lenses. Failure to remove contacts during a procedure could result in corneal abrasion.

For your safety: It is mandatory that a responsible adult stay with you during your stay with us.   You will not be able to drive yourself home.  Due to the risk to your personal safety you will not be allowed to take public transportation or a taxi home.

ONE WEEK BEFORE THE EXAM:

STOP ALL IRON,  ASPIRIN, BLOOD THINNERS, ARTHRITIS MEDICINES, ANIT-INFLAMMATORY MEDICINE AND ALL VITAMINS AND SUPPLEMENTS . Do not eat any products containing Olestra/Olean (WOW potato chips).  You may take Tylenol, if needed.

You will need to purchase the following:

1. Dulcolax (bisacodyl-generic) tablets.  (Available (otc) from your local pharmacy)
2. Gatorade, PowerAde, Crystal Light or any clear liquid of choice.  (Nothing red in Color).
3. 255g bottle of Miralax (your doctor will give you a prescription)

The day before the exam:

1. Start a clear liquid diet the day before the exam.  Follow instructions for “clear liquid diet”.  Do not eat or drink anything red in color.
2. At 12 noon take 2 Ducolax tablets by mouth.
3. At 1 pm, mix 2 17gm capfuls of Miralax with a glass of clear liquid of your choice and drink it. 
4. At 1:30 pm, repeat step 3 and repeat again every 30 to 45 minutes until you have finished 8 glasses of clear liquid with the Miralax mixture.
5. At 4 pm take another 2 Dulcolax tablets:  Remember that these are laxatives you are taking so stay close to the restroom or close to home.
6. DO NOT EAT OR DRINK ANYTHING AFTER MIDNIGHT THE NIGHT BEFORE THE EXAM.

If you are a diabetic, take ½ of your usual dose of medication today-morning dose only.

The day of the exam:

1. DO NOT take any medications the morning of the exam.  Bring all medicine for Diabetes, any Heart Medicines and Medicine for High Blood Pressure with you to the exam.
2. Do not wear contact lenses to the procedure.  You may bring a case with your lenses.  Failure to remove contacts during a procedure could result in corneal abrasion.

For your safety: It is mandatory that a responsible adult stay with you during your stay with us.   You will not be able to drive yourself home.  Due to the risk to your personal safety you will not be allowed to take public transportation or a taxi home.

(The day before your exam a member of our Endoscopy Suite will contact you to confirm your arrival time to our facility.)

1. STOP ASPIRIN, BLOOD THINNERS, ARTHRITIS MEDICINES OR ANY OTHER ANIT-INFLAMMATORY MEDICINE ONE-WEEK PRIOR TO YOUR EXAM.
2. DO NOT eat or drink anything after midnight the night before your exam.  (You may eat and drink UP TO, but NOT AFTER midnight.)
3. If you are on high blood pressure medicine or steroids (prednisone, for example), you may take the medicine with just enough water to swallow.
4. Do not wear contact lenses to the procedure.  You may bring a case with your lenses.  Failure to remove contacts during a procedure could result in corneal abrasion.
5. If you are unclear about these prep instructions and it is after office hours the night before your exam, call the office and our answering service will contact the doctor on call.

(The day before your exam a member of our Endoscopy Suite will contact you to confirm your arrival time to our facility.)

1. At 5 pm the day before the exam you must begin a clear liquid diet. See instructions for “Clear Liquid Diet”.  (You may have a noon meal.  This is your last solid food until after the exam.)
2. Drink one bottle of Magnesium Citrate at 5 pm the evening before the exam. 
3. The day of the exam you may have a clear liquid breakfast.
4. Two hours before the exam complete 2 Fleet Enemas.  (Take one then repeat in 15 to 30 minutes.)
5. Do not wear contact lenses to the procedure.  You may bring a case with your lenses.  Failure to remove contacts during a procedure could result in corneal abrasion.
6. If you are unclear about these prep instructions and it is after office hours the night before your exam, call the office and our answering service will contact the doctor on call.

For your safety: It is mandatory that a responsible adult stay with you during your stay with us.   You will not be able to drive yourself home.  Due to the risk to your personal safety you will not be allowed to take public transportation or a taxi home.

(Endoscopic Retrograde Cholangiopancreatography. Special Study of the ducts of the gallbladder/pancreas.)

1. STOP IRON, ASPIRIN, BLOOD THINNERS, ARTHRITIS MEDICINES OR ANY OTHER ANIT-INFLAMMATORY MEDICINE ONE WEEK PRIOR TO YOUR EXAM.
2. DO NOT eat or drink anything after midnight the night before your exam.  (You may eat and drink UP TO, but NOT AFTER midnight.)
3. If you are on high blood pressure medicine or steroids (prednisone, for example), you may take the medicine with just enough water to swallow.
4. Do not wear contact lenses to the procedure.  You may bring a case with your lenses.  Failure to remove contacts during a procedure could result in corneal abrasion.
5. Occasionally overnight observations may be necessary.  Please bring any personal articles you may need.
6. If you are unclear about these prep instructions and it is after office hours the night before your exam, call the office and our answering service will contact the doctor on call.

For your safety: It is mandatory that a responsible adult stay with you during your stay with us.   You will not be able to drive yourself home.  Due to the risk to your personal safety you will not be allowed to take public transportation or a taxi home.

Financial Responsibilities of the Patient

Thank you for choosing Southern Endoscopy Suite. There are some important terms to know if contacting your own insurance carrier for information regarding your benefits.

If you are checking your benefits with your insurance company please understand that we do not do colonoscopys, endoscopies or any other procedure in the office. These procedures are done at Southern Endoscopy Suite, LLC, our Ambulatory Surgical Center (ASC) Permit No. 067-200. Our facility is Medicare Certified and accredited with the Association for Ambulatory Health Care, Inc. (AAA). Southern Endoscopy Suite is located ‘in the same building’ as our Lawrenceville clinic location. Procedures done in our Endoscopy Suite are NOT office procedures.  They are procedures performed in an Outpatient Setting.

Our surgery scheduler will gladly assist you with contacting your insurance company to verify coverage and determine what your financial responsibility should be. Verification of benefits is not a guarantee of payment.

You can expect the following bills as a result of your procedure:

• Physician Fee: Fee to be paid to the physician for the performance of the service.  This bill will be from Southern Gastroenterology Associates.
• Facility Fee: Fee to be paid for the use of the facility for your procedure.  This fee covers the cost of facility staff, equipment, and supplies.  This bill will be from Southern Endoscopy Suite, LLC.
• Anesthesia Fee: Fee to be paid for services from theanesthesia group for anesthetic, anesthesiologist services, vitals monitoring.  This bill will be from Anesthesia Healthcare Partners (AHP)
• Pathology Fee:  This fee is for any tissue biopsy and the processing of the biopsy. This bill will be from Caris Diagnostics.
  

(The above will vary if having your procedure done in a hospital setting. Consult the hospital with questions.)

• Your insurance will send you an explanation of benefits that will explain how your bill was broken down and paid.  It will also tell you the amount that remains your responsibility.   The explanation of benefits (EOB) is NOT a bill.  Do not pay from the EOB.

Each of the companies listed above will have a copy of the EOB and payment from your insurance.  Once the payment has been processed you will receive a bill.  If you have questions after receiving a BILL, please call our business office at 678-985-1994. 

Special Note:  A deposit will be requested prior to your procedure.   We ask for a 72-hour notice of cancellation in order to better serve our patients in minimizing costs.  A missed appointment or late cancellation will result in a $50.00 charge.   This payment is the responsibility of the patient.