Gastroenterology Specialists, Incorporated
6565 South Yale – Suite 1200
Tulsa, Oklahoma 74136
(918) 494-9433
Fax (918) 494-9499
9228 South Mingo Suite 102
Tulsa, Oklahoma 74133
(918) 806-5222
Fax (918) 494-9499
Thomas D. Schiller, M.D.
John R. Hood, M.D.
Michael J. Martin, M.D.
William K. Briggs, M.D.
Roy L. Thompson, M.D.
Jeffrey L. Bigler, M.D.
Sheldon C. Berger, D.O.
David W. Morris, D.O.
Geoffrey A. Fillmore, D.O.
COLONOSCOPY PREPARATION Prepopik
Colonoscopy requires the large intestine to be clean in order to visualize its lining. The preparation the
doctors have chosen does not require laxative or enemas. The solution used is balanced salt solution, which
will be taken by mouth the night prior to the procedure. The prep is better tolerated and tastes better if it is
refrigerated. NOTE: individual responses to laxatives vary. The prep may cause multiple bowel
movements. Often it works within 30 minutes; although sometimes it may take as long as 3 hours to start
working. Please remain within easy reach of the toilet facilities.
 5 DAYS BEFORE THE EXAMINATION: Stop Aspirin products, Anti-Inflamatories, Plavix
(generic Clopridogrel), Coumadin, or any medications (including generic brands) that may thin
blood.
 3 DAYS BEFORE EXAMINATION: Stop bulk laxatives (Metamucil, Effersyllium, etc.) and
iron supplements.
 DAY BEFORE EXAMINATION: Drink only “clear liquids” for breakfast, lunch and dinner.
Solid foods, milk or milk products are not allowed.
 CLEAR LIQUIDS INCLUDE: Strained fruit juices with out pulp (apple, white grape,
lemonade); water; clear broth or bouillon; coffee or tea (without milk or non dairy creamer);
Gatorade; Carbonated and non-carbonated soft drinks; Kool-Aid (or other fruit flavored drinks);
Plain Jell-O (without added fruit or toppings); Ice Popsicles; Please avoid “ Clear Liquids” with
red or purple dyes, such as red Jell-O or purple grape juice, as this may have the appearance and
can be confused with blood after taking a prep.
 DAY BEFORE THE EXAMINATION: at 2:00 PM mix one packet of bowel prep with 5oz of
water and drink entire contents. Drink 5 additional 8 oz glasses of water at a comfortable rate.
Then at 8:00 PM repeat the previous steps.
 NOTHING BY MOUTH AFTER MIDNIGHT: You may brush your teeth the morning of the
exam and take only the medications outlined by your physician.
o
Please wear loose fitting, comfortable clothing
ON THE DAY OF THE PROCEDURE, PLEASE BRING A LIST OF YOUR MEDS AND
ALLERGIES.
Report To:
Report Time:
Date:
PLEASE BE SURE YOU HAVE A DRIVER WHO CAN REMAIN IN THE OFFICE THROUGH OUT
THE ENTIRE PROCEDURE. IF YOUR DRIVER IS NOT PRESENT AT YOUR CHECK-IN TIME
YOUR PROCEDURE WILL BE RESCHEDULED.
Gastroenterology Specialists, Incorporated
6565 South Yale – Suite 1200
Tulsa, Oklahoma 74136
(918) 494-9433
Fax (918) 494-9499
Thomas D. Schiller, M.D.
John R. Hood, M.D.
Michael J. Martin, M.D.
William K. Briggs, M.D.
Roy L. Thompson, M.D.
Jeffrey L. Bigler, M.D.
9228 South Mingo Suite 102
Tulsa, Oklahoma 74133
(918) 806-5222
Fax (918) 494-9499
Sheldon C. Berger, D.O.
David W. Morris, D.O.
Geoffrey A. Fillmore, D.O.
Home Care Instructions for Sedation Procedures
During your procedure, you will receive some medicine that may affect your memory of the day’s events.
Other normal side effects of the medicine may include confusion, irritability, drowsiness or a drunken like
state. Resting at home is the best way to recover.
Activity:
Your speech, posture, hand control and ability to work may be affected for 24 hours.
Someone should stay with you for your safety.
A responsible person needs to drive you home after the procedure.
Do not drive or operate any machinery for 24 hours.
IF THIS ARRANGEMENT HAS NOT BEEN MADE, YOUR PROCEDURE WILL BE
CANCELED.
Diet:
Resume your usual diet unless instructed otherwise by your physician.
Do not drink alcoholic beverages for 24 hours.
Care at Home:
We recommend that you have a responsible person stay with you for the remainder of the day and during
the night for your safety.
Someone should check on you every hour until your usual bedtime.
Medicines:
If you take prescription medicines on a regular basis, ask your physician which ones you should take after
your procedure.
Do not take any muscle relaxants, sedatives, hypnotics or mood altering medicines for 24 hours unless
ordered by your physician.
If you have pain, you may take over the counter medicines such as Tylenol
The medicine should be taken as directed on the label.
Other Information:
Do not make any important decisions or sign important documents for 24 hours.
Call Your Physician for any Questions or if you notice any of the following:
 Blue skin color
 Difficulty breathing
 Unable to arouse
 Pain not relieved by medicine
 Bleeding
 Fever or chills
Gastroenterology Specialists, Incorporated
6565 South Yale – Suite 1200
Tulsa, Oklahoma 74136
(918) 494-9433
Fax (918) 494-9499
Thomas D. Schiller, M.D.
John R. Hood, M.D.
Michael J. Martin, M.D.
William K Briggs M.D.
Roy L. Thompson, M.D.
Jeffrey L. Bigler, M.D.
9228 South Mingo Suite 102
Tulsa, Ok. 74133
(918) 806-5222
Fax (918) 494-9499
Sheldon C. Berger, D.O.
David W. Morris, D.O.
Geoffrey A. Fillmore, D.O.
Agreement to Provide Support & Assistance Following
Endoscopy Procedure
For Patient:___________________________________
Date:________________
This document certifies that I,
_____________________________ Am a
Responsible adult and as such agree to provide services on behalf of the above named
patient of the Gastroenterology Specialists, Inc. Center.
 I will wait in the Gastroenterology Specialists, Inc. waiting room and will be
available at the end of procedure.
 I agree to receive formal discharge instructions from the physician or nursing
staff.
 I agree to drive the above-named patient home following his/her discharge.
 I will be available to handle possible post-procedure complications (as will be
explained by the physician or nursing staff).
I will accept the responsibilities outlined above.
Driver’s name here (Print):_______________________________________________
Driver’s signature here:_________________________________
Date:___________