You have been scheduled for a colonoscopy exam at ima endoscopy surgicenter

TO SCHEDULE: 219-736-4662 FAX: 219-736-4663 24 HOUR ANSWERING: 219-738-2081
You have been scheduled for a colonoscopy exam at IMA Endoscopy SurgiCenter.
Please arrive on

NOTE: You must have a driver present when you arrive for your procedure. Your driver must remain in the
waiting room during your procedure. Public transportation or cabs are not allowed.
Your Medication

If you take Coumadin, Plavix, Pradaxa, Aggrenox, Effient, or any blood thinners, please notify our staff if
you have not received instruction regarding this medication. Blood pressure and heart medication
must be taken the morning of the procedure.

Diabetic patients should take ½ the usual dose of insulin/diabetes medication on the day before the
procedure. No insulin or other diabetes medication should be taken the morning of the procedure. Please check your blood sugar the morning of the procedure and tell your nurse the reading.
IMPORTANT: In addition to the prep, please drink additional clear liquids before, during and after
drinking the prep solution. STOP DRINKING LIQUIDS 3 HOURS BEFORE YOU ARE
SCHEDULE TO ARRIVE AT IMA Endoscopy SurgiCenter or the procedure will be
cancelled and rescheduled. Not even a sip!!

PREP: Four Dulcolax tablets and two 10 oz bottles of lemon-lime Magnesium Citrate. This must be
purchased at your local pharmacy. No prescription is necessary.
DIET: The day before the procedure eat a light breakfast and lunch (by noon). This could include
eggs, white bread, pasta, and rice. Please do not eat raw/fresh fruits or vegetables. After lunch you
must start your clear liquid diet. Please look on the back of this page for acceptable choices. Do
not drink any dairy products or anything containing artificial red dye.
Take 2 Dulcolax tablets and one bottle of Magnesium Citrate at 6:00 p.m. the day before

 Take 2 Dulcolax tablets and one bottle of Magnesium Citrate ___________________________.
Splitting the dose of the prep solution provides you the best colon exam possible.

IMA Endoscopy SurgiCenter is an Accreditation Association for Ambulatory Health Care (AAAHC) accredited

facility owned and operated by the physicians of Internal Medicine Associates.

IMA Endoscopy SurgiCenter physicians and staff encourage your participation in your care. If you or your family have any
concerns related to your care, treatment, services or patient safety while under our care, please discuss this with your
physician or contact the Clinical Director/Administrator at 219-736-4660 ext. 138. You may also contact the AAAHC at 847-
853-6060; or the Indiana State Department of Health, Director of Acute Care, 2 North Meridian, Indianapolis, IN 46204; or by phone at 866-220-5810; or the Medicare Beneficiary Ombudsman at 800-MEDICARE, or online at



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Dr. Isabel Quijada Garrido Tenured Researcher Department of Physical Chemistry of Polymers Institute of Polymer Science and Technology C/Juan de la Cierva 3, Madrid 28006, Spain Tel.: +34-91-5622900 ext 254 Fax: +34-91-5644853 E-mail:[email protected] Isabel Quijada is currently Tenured Research (2007) at the Institute of Polymer Science and Technology (ICTP) at the Spanish National Resea

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