scheduled for a Colonoscopy / EGD on ___________________________ at
Endoscopy Unit, South Tower,
Camden Clark Hospital, Parkersburg, WV
Call the same day registration
304-424-2778 to schedule your preoperative assessment at least 3-4 days prior to procedure
Stop the Following Medication ________________On_________________________
You need I bottle of Miralax or Glycolax (238 grams),
64 ounces Gatorade , 1 bottle of 10 ounces Magnesium citrate Clear or green only and 2 Dulcolax tablets
Avoid eating corn, broccoli, beans, nuts and green vegetables 3 days before the procedure
Stop iron and fiber supplements
5 days before procedure
Day before procedure
diet only. This includes Soda, Apple juice, Gatorade, Jell-O, Tea and coffee without milk, Jell-O etc. Avoid
red colored liquids or Jell-O
Mix the whole bottle of miralax in 64 ounces of Gatorade or clear liquid
of your choice and put it in the refrigerator in the morning
At 2: 00 PM take 2 Dulcolax tablets
At 4:00 PM start-drinking miralax mixed in Gatorade. Drink 8 ounces of miralax / Gatorade every 15 minutes as tolerated.
If you get nauseous you may slow down and start after 15-30 minutes.
At 10:00 PM drink one bottle of
Day of Procedure
Report to the Hospital 45 minutes
before the procedure time.
Stay fasting until the procedure. You may take your blood pressure medications with sips
of water. Do not take you diabetes medications until after the procedure.
Procedure times or location may sometimes
change. You will be notified of any changes.
notify 3-4 days before procedure, if you are unable to keep this appointment. We reserve the right to charge $200 for
procedures cancelled later than 3 business days prior to scheduled procedure date without a valid urgent reason