MIDDLESEX SURGICAL ASSOCIATES, INC.
955 MAIN STREET, SUITE G2A
WINCHESTER, MA 01890
VOICE: 781-729-2020
AFFILIATED WITH TUFTS UNIVERSITY
SCHOOL OF MEDICINE
WILLIAM L. BRECKWOLDT, M.D., F.A.C.S.
KELLEY M. CORNELL, M.D., F.A.C.S.
PATRICK F. BROPHY, M.D., F.A.C.S.
MARTA QUIJANO, M.D.
NAYOMI EDIRISINGHE, M.D., F.A.C.S.
LIMARIS BARRIOS, M.D., F.A.C.S.
KATHLEEN SLOPER, A.N.P.
FAX: 781-729-6846
INSTRUCTIONS FOR PRE-ADMISSION TESTING
APPOINTMENT
APPOINTMENT DATE: _________________________TIME:___________
SURGERY DAE: ________________________________
Patient’s Name: _________________________________
If the doctor’s office has not schedules an appointment for you, please call the
scheduling office at 781-756-2211 to schedule on within approximately one
week of surgery.
WHAT TO BRING TO YOUR APPOINTMENT:





Paper received from your doctor, if applicable
o Examples: Consent forms, Order Sheet etc.
Insurance Information
List of Allergies
List of Medications, including dose
Name and telephone number of a relative or friends who will taking you
home after your surgery.
DAY OF YOUR APPOINTMENT:

Please report directly to Central Registration department location on the
ground floor of the hospital.
PURPOSE OF YOUR APPOINTMENT:



To review your past medical history.
To complete necessary testing before your surgery.
To explain and answer questions about getting ready for surgery, the
surgical routine and recovery and discharge planning.
MIDDLESEX SURGICAL ASSOCIATES, INC.
955 MAIN STREET, SUITE G2A
WINCHESTER, MA 01890
VOICE: 781-729-2020
FAX: 781-729-6846
AFFILIATED WITH TUFTS UNIVERSITY
SCHOOL OF MEDICINE
WILLIAM L. BRECKWOLDT, M.D., F.A.C.S.
KELLEY M. CORNELL, M.D., F.A.C.S.
PATRICK F. BROPHY, M.D., F.A.C.S.
MARTA QUIJANO, M.D.
NAYOMI EDIRISINGHE, M.D., F.A.C.S.
LIMARIS BARRIOS, M.D., F.A.C.S.
KATHLEEN SLOPER, A.N.P.
OUTPATIENT
Cat Scan Oral Contrast Instructions- A.M.
Your appointment is booked for the morning of ______ at ______.
Date
Time
You will be given 2 bottles of oral contrast (barium).
We would like you to drink 1 bottle of barium at your bedtime the evening
before your exam.
1 hour before your exam, drink the entire 2nd bottle.
You may also take any medications that you need. Have nothing else to
eat or drink.
The barium will taste better cold, but it does not need to be refrigerated.
You should arrive 15 minutes before your appointment time.
If you have any questions, please call the location at which your exam
is going to be performed:
 Winchester Hospital-CAT Scan
 Unicorn Park, Suite 402
781-756-2357
781-756-4008
MIDDLESEX SURGICAL ASSOCIATES, INC.
955 MAIN STREET, SUITE G2A
WINCHESTER, MA 01890
VOICE: 781-729-2020
FAX: 781-729-6846
AFFILIATED WITH TUFTS UNIVERSITY
SCHOOL OF MEDICINE
WILLIAM L. BRECKWOLDT, M.D., F.A.C.S.
KELLEY M. CORNELL, M.D., F.A.C.S.
PATRICK F. BROPHY, M.D., F.A.C.S.
MARTA QUIJANO, M.D.
NAYOMI EDIRISINGHE, M.D., F.A.C.S.
LIMARIS BARRIOS, M.D., F.A.C.S.
KATHLEEN SLOPER, A.N.P.
OUTPATIENT
Cat Scan Oral Contrast Instructions- P.M.
Your appointment is booked for the morning of ______ at ______.
Date
Time
You will be given 2 bottles of oral contrast (barium).
You may eat a light meal up to 4 hours prior to your scan.
Drink the 1st bottle 3 hours prior to your exam.
1 hour before your exam, drink the entire 2nd bottle.
The barium will taste better cold, but it does not need to be refrigerated.
You should arrive 15 minutes before your appointment time.
If you have any questions, please call the location at which your exam
is going to be performed:
 Winchester Hospital-CAT Scan
 Unicorn Park, Suite 402
781-756-2357
781-756-4008