Microsoft word - a-moviprep- full packet

MOVIPREP®
North Jersey Gastroenterology and Endoscopy Associates
1825 Route 23 South, Wayne, NJ 07470
Telephone 973-633-1484
Patient:_______________________________________________
Date of procedure:________________ Arrival time for procedure: _______________________
Endoscopy Center, 1st Floor Chilton Hospital Access Center Wayne Surgical Center
1825 Rt 23 S Wayne, NJ 97 W Parkway Pequannock, NJ 1176 Hamburg Tpke Wayne, NJ

DIET: No iron supplment, seeds, nuts, corn, popcorn, tomatoes, cucumbers, quinoa or salad for three days before the
procedure.
PREPARATION: Please obtain the following items from your pharmacy before the procedure:
1. Two (2) Bisacodyl tablets – 5 mg each (over the counter).
2. MoviPrep kit (by prescription only).
ON THE DAY BEFORE THE PROCEDURE:
1. Before 10 am., you may have a light breakfast. This can include cereal, breads, and milk products, but cannot
include fresh fruits, vegetables, salad or meats. 2. After 10 a.m., only clear liquids can be consumed. Clear liquids are as follows:
Clear juices (apple, white grape, not red) 3. At 5 p.m., take the two 5 mg Bisacodyl tablets with water.
4. At 6 p.m. start MoviPrep; Please make sure to follow the instructions below-they are slightly different
than the instructions given on the MoviPrep box. Empty 1 pouch A and 1 pouch B into the disposable
container, add water to the top line of the container. Mix to dissolve. The MoviPrep container is divided by 4
marks. Drink a glass (about 8 ounces) every 10 to 15 minutes until the bottle is empty. Bowel movements
may begin to occur about one hour after the first glass of solution and may continue two to four hours after
you finish the last glass. It is more easily tolerated if chilled and taken with a straw. Feelings of bloating,
nausea or chills are common after the first few glasses. This is temporary and will decrease once bowel
movements begin. If the nausea worsens, stop drinking the solution for 30 minutes, then resume drinking
every 15 minutes as before. (NOTE: The flavor packets are colorless and will not add color to the
preparation).
ON THE DAY OF THE PROCEDURE:
1. Six hours prior to the procedure repeat the Moviprep step above: Empty 1 pouch A and 1 pouch B into the
disposable container, add water to the top line of the container. Mix to dissolve. The MoviPrep container is divided by 4 marks. Drink a glass (about 8 ounces) every 10 to 15 minutes until the bottle is empty. 2. Following the prep, you should expect to have clear yellow fluid passing into the toilet. 3. Wear loose, comfortable clothing. Bring your glasses (if necessary). Do not bring valuables such as jewelry with you. The endoscopy facility cannot be responsible for your belongings. You must finish taking all liquid (PREP AND WATER) at least 5 hours prior to scheduled
arrival time or your procedure will be delayed.
****DO NOT CONSUME ANYTHING ELSE BY MOUTH-NOT EVEN WATER.****
**IMPORTANT- Please make sure to follow the instructions as written. They are different than the instructions that come with the Moviprep kit. ADDITIONAL INFORMATION:
1. If you take blood pressure pills, pills for your heart, seizure medications or Parkinson’s medications, take them as usual with a small amount of water. Ask your doctor if you are not sure. 2. If you take daily aspirin, Coumadin, Plavix, Ticlid, vitamin E, aspirin, Advil, Nuprin, Motrin or any other “anti- inflammatory/arthritis pills make sure you have discussed this with your physician. 3. If you take Coumadin, take the last dose: _____________________________________
4. After the procedure, you must not drive, work or do anything that could result in injury.
5. YOU MUST HAVE A RIDE HOME OR THE PROCEDURE WILL BE CANCELLED! Your ride should
be available 1 ½ hours after you are dropped off for your procedure. Rev 6/13

Source: http://www.njgastro.com/docs/Moviprep-.pdf