FAX COVER SHEET - Gastroenterologist



COLONOSCOPY PROCEDURES:

AUTHORIZATION:

You require authorization for this procedure. 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. If you are being done in the hospital, you will need to pre-admit yourself 2 – 3 days prior to the procedure. A form will be given to you from the doctors’ rooms to do so.. On the day of the procedure please bring your medical aid card together with the authorization number to the hospital.

Have the following ready when you call the medical aid for authorization:

Main member and medical aid number

Patient name and Date of birth

Procedure code: for colonoscopy 1653, polypectomy (if done) 1654

Reasons for procedure i.e. Symptoms, like diarrhoea, blood in the stool, abdominal pain etc

ICD CODE: ________(THE REASON FOR THE PROCEDURE).

PRACTICE NUMBERS:

Dr ES Fredericks: 0073334

Hospital Practice No: 5807875

IMPORTANT INFORMATION:

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

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

Bring along any other medicine you may need to take later.

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

IMPORTANT DO NOTS:

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

As you may forget, 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.

LEVIES:

Colonoscopy: R 200 (Cash or Cheque)

Polypectomy (only if done): R75 additional

PREPARATION:

You need a prescription for 3 sachets Picoprep.

DAY BEFORE PROCEDURE:

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

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

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

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 solids.

NO DAIRY PRODUCTS

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

DAY OF PROCEDURE:

Have liquid breakfast. Tea/coffee, soup, energy drink

Take chronic medication as required.

Drink clear fluids as needed.

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