Gastroenterology (858) 657-6882 ENDOSCOPIC RETROGRADE

(858) 657-6882
Patient Name:
Date of Procedure:
ORSOS Case Number:
Check In Time:
Physician Performing Procedure:
Time of Procedure:
Check-in Information and Address of Procedure Site:
 UCSD Thornton Hospital in La Jolla: 9300 Campus Point Drive, La Jolla, CA 92037. Check in at
the admissions/patient access reception desk on the 1st floor. There is no free parking.
Please bring a picture ID and insurance card for check-in. You will be given intravenous sedation
before and during the procedure and therefore, you must arrange for a responsible adult to drive you
home after the procedure, or accompany you if you are taking a taxi or public transportation. You
will be ready to go home about 3 - 4 hours from your check in time. You may not drive for 24 hours after
the procedure or make any legally binding decisions the rest of the day.
A 72 HOUR NOTICE IS REQUIRED. Call 858-657-6882, and leave a cancellation message. Please
include your name, medical record number (MRN) and message.
Emergency questions:
After hours or weekends call (619) 543-6737 and ask for the G.I. fellow on-call for emergency questions.
One Week Before the Procedure:
1) If you take a blood thinner (such as Coumadin or Plavix) call your prescribing doctor to ask if you
can stop before the procedure (usually 3-5 days before).
2) If you take a diabetic medication (insulin or oral), please contact your prescribing doctor for
medication instructions.
3) Stop taking iron supplements including multi-vitamins with iron.
The Day of the Procedure:
1) Take any important medications such as medication for high blood pressure, irregular
heartbeats, seizures, or pain medications. Take all other medications after your procedure.
2) Do not eat or drink anything starting 7 hours before your check-in time, until after your procedure.
3) Your responsible adult driving or accompanying you home must be present or available by phone
when you check in. Not doing so will result in rescheduling your procedure.
4) Bring the completed medication reconciliation form and the completed medical history
form with you to check-in.
PH800 (R 9/09)