FAX COVER SHEET - Gastroenterologist



GASTROSCOPY AND COLONOSCOPY PROCEDURES:

AUTHORIZATION:

You require authorization for both procedures. Phone your MEDICAL AID on the telephone number at the back of your medical aid card. Inform your MEDICAL AID that the procedure will be done in DOCTORS ROOMS/HOSPITAL. On the day of the procedure please bring your medical aid card together with the authorization number to the hospital. You also need to pre-book the hospital admission for the day (if you are to be done in hospital). This requires a special hospital form (we will supply that) that must be filled out prior to the procedure itself.

REQUISTITION FOR AUTHORIZATION:

Main member number

Patient name and Date of birth

ICD CODE: ______ and ______ (THE REASON FOR THE PROCEDURE).

PROCEDURE CODE:

GASTROSCOPY: 1587

COLONOSCOPY: 1653

POLYPECTOMY: 1654 (only if it is done)

PRACTICE NUMBERS:

Dr ES Fredericks: 0073334

Hospital: 5807875

IMPORTANT INFORMATION:

Please inform us if you are taking any blood thinning medication like Plavix or Warfarin prior to procedure.

Bring along any other daily medicine so that you may take them after the procedure.

REFRAIN from daily tasks especially driving 6-8 hours after the procedure.

All chronic medications for hypertension, diabetes, heart disease etc must be taken early, ± 6am on the day of the procedure

Inform us if you are diabetic, had a heart valve replacement or scheduled for any major surgery.

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LEVIES: (cash or cheques – no card system)

Gastroscopy and Colonoscopy: R250

With polypectomy: R175

IMPORTANT DO NOT’S:

You may NOT drive. Arrange for someone to bring and fetch you.

As you may not remember anything afterwards, we strongly recommend that a relative accompany you when the doctor discusses your results with you.

DO NOT - sign any legal documents/cheques

- operate heavy machinery for at least 24 hours after the procedure.

PREPARATION:

You need a prescription for 3 sachets Picoprep

DAY BEFORE PROCEDURE:

Have a light breakfast e.g. black tea and toast and scrambled egg.

Mix 1st sachet (Picoprep) with 1 glass of lukewarm water and sip over ± 10-15 minutes at 13:00(1pm).

Mix 2nd sachet (Picoprep) with 1 glass of lukewarm water and sip over ± 10-15 minutes at 16:00(4pm).

Mix 3rd sachet (Picoprep) with 1 glass of lukewarm water and sip over ± 10-15 minutes at

18.00 (6pm).

Must not have any solid food.

NO DAIRY PRODUCTS

For lunch and dinner have liquid diet like strained soup, jelly and Bovril.

Drink enough clear fluids during the day. These include water, soda water, apple juice, flavoured water, black rooibos tea/coffee.

No eating or drinking for at least 6 hours before the procedure.

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