Rectal eus instructions
No Show/Late Cancellation Policy
This policy has been established to help us serve you better.
It is necessary for us to make appointments in order to see our patients as efficiently as possible.
No-shows and late-cancellations cause problems that go beyond a financial impact on our
practice. When an appointment is made, it takes an available time slot away from another
patient. No-shows and late-cancellations delay the delivery of healthcare to other patients, some
who are quite ill.
A “no-show” is missing a scheduled appointment. A “late-cancellation” is canceling an
appointment without calling us to cancel within 24 hours of an office appointment or 72 hours in
advance of a procedure.
We understand that situations such as medical emergencies occasionally arise. These situations
will be considered on a case by case basis.
A charge of $25.00 will be assessed for each no show or late cancellation
office visit appointment if less than 24 hours notice is given.
A charge of $200.00 will be assessed for each no show or late
cancellation procedure appointment if less than 72 hours notice is
Please understand that insurance companies consider this charge to be entirely the patient’s
To cancel or reschedule an appointment please call Galen Medical Group at 423-643-2500 and
speak with the operator. This policy is in effect to ensure that all of our patients have the
opportunity to be seen in a timely manner.
_________________________________________ Date: _____________________ Patient Acknowledgement (please sign)
Instructions for Preparing For Your Lower EUS
(Colon & Rectal Endoscopic Ultrasound)
Your Physician is:
___Dr. Colleen Schmitt
___Dr. Sumeet Bhushan
___Dr. M. Rad. Yates,
___Dr. Chad Charapata
___Dr. Marshall Horton
___Dr. Larry Shuster
___Dr. Gregory Olds
Your Physician’s Phone Number is: ____423-643-2500, ____423-870-2450, ____423-648-0787
***Procedure Time and check-in time are subject to change; the location checked below will
provide you with a definite check-in time.***
You MUST have a responsible adult present to drive you home.
Your procedure is scheduled at the following location:
____ Memorial North Park Hospital
Located on Hamill Road near Highway 153. Enter through the emergency room entrance and sign in at the registration desk. The phone number is 423-495-7389.
_____ Memorial Hospital
Located at 2525 deSales Avenue. Call 495-7777 for directions.
On the day before your procedure, do not eat any solid food. You may have a clear liquid diet
consisting of the following:
• Clear soft drinks, such as lemon-lime sodas, ginger ale, etc.
• Apple, white grape or white cranberry juice. (Do not drink orange, tomato or grapefruit juices.)
• Beef or chicken bouillon cubes, melted in warm water to make a clear soup.
• Jell-o® gelatin, any color except red*. Do not add fruit.
• Tea or coffee with or without sugar. Do not add cream, milk or powdered milk or creamer.
• Kool-Aid® Gatorade®, or Popsicles®, any color except red*.
*Red dye leaves a red color in the colon, making evaluation difficult.
DO NOT HAVE ANYTHING TO EAT OR DRINK AFTER MIDNIGHT!
This includes gum, candy, mints, or ice chips
Please turn form over for further instructions
PREPARING FOR YOUR PROCEDURE:
Only your physician can choose the proper colon preparation based on careful review of your medical
history. Please follow precisely the enclosed preparation your physician has chosen for you. Certain
medical conditions prohibit the use of some colon preparations. Using an inappropriate preparation, or
failing to follow instructions carefully, could be dangerous to your health. Follow the clear liquid diet the
day prior to your procedure and the enclosed laxative preparation. MEDICATION INSTRUCTIONS:
Do not take these medications for seven (7)
days before your colonoscopy:
Aleve® (Naprosyn) Bextra®
Do not take anything for arthritis, pain or headaches other than Tylenol® (acetaminophen) without consulting with our offices first. If you take blood thinners, which may include these listed below, call our office for instructions: Coumadin®, warfarin*
*If you take Coumadin® or warfarin, you will need to have your Protime/INR (lab) drawn the day before
Please call our office if you are taking any other blood-thinning medications for heart or stroke conditions
that are not listed above.
If you take Glucophage® (metformin) for diabetes, you should stop 24 hours (1 day)
prior to your
colonoscopy (do not take your dosage the day prior to your procedure).
If you take insulin, you need to contact your diabetes doctor ahead of time to let your doctor know about
the clear liquid diet. Your doctor’s office will be able to tell you how to adjust your insulin. Please take your morning dosage of your heart and/or blood pressure medication with a small sip of
water the morning of your procedure. Otherwise, do not eat or drink anything after midnight.
Please make arrangements to have someone drive you home. You will only be discharged to the care of a
responsible adult who can understand and follow your discharge instructions. You will not be allowed to
take a taxi cab home.
After your discharge, you will be asked to limit your activity until the following day due to the
sedation/anesthesia; including making critical decisions, operating machinery, or participating in activity
requiring good hand-eye coordination. You will not be released to drive until the morning after the
After the procedure, the physician will talk to you and/or your family member to discuss the findings. If a
biopsy was taken or polyp(s) removed, the pathology results will be back in approximately seven days. If
you haven’t heard from our office in 2 weeks regarding your results, please call. If the physician thinks
there is an emergency, you will be called immediately.
Thank you for allowing us to take care of you.
We are so glad that you have chosen to accept our invitation to allow your child to attend Echo Lake Bible Camp this summer. Campers are sure to have a great time making new friends, learning about God, and enjoying all the wonderful activities we have planned! Once you have completed the registration form and attached your registration fee, please mail to the following address: ECHO LAKE BIBLE
ANAPHYLAXIS MANAGEMENT & ACTION PLAN Patient’s Name _____________________________________________________ DOB _____________________________ Date Completed __________________ Parents’ Name _____________________________________________________ Permission to carry meds? _______yes __ _ no ___ My child has food, contact, medication or insect bite allergies that could require use of epine