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Frank J. Farrell, M.D. Cathleen N. Cabana, M.D. Nancy Ho, M. D p: 415.749.6900 | f: 415.402.0530 | www.sfgimd.comENDOSCOPY PREPARATION SHEET PLEASE READ THIS AT LEAST SEVERAL DAYS AHEAD OF YOUR PROCEDUREYour
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01
Read the entire endoscopy preparation sheet carefully to understand all instructions.
02
Gather necessary materials, such as a pen and any previous medical records you may need.
03
Complete personal information sections including name, date of birth, and contact information.
04
Provide details about your medical history, including any current medications, allergies, and previous surgeries.
05
Follow dietary instructions, noting any required fasting periods leading up to the procedure.
06
Confirm arrangements for transportation if sedation is required during the endoscopy.
07
Sign and date the form, acknowledging that you understand the instructions.

Who needs endoscopy preparation sheet please?

01
Patients scheduled for an endoscopy procedure.
02
Individuals with medical conditions that may require internal examination.
03
Doctors or healthcare providers who are coordinating patient care prior to an endoscopy.
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An endoscopy preparation sheet is a document that outlines the necessary steps and guidelines for patients to follow before undergoing an endoscopic procedure, ensuring a safe and effective examination.
Typically, the healthcare providers conducting the endoscopy are required to complete and file the endoscopy preparation sheet to document that the patient has been adequately prepared for the procedure.
To fill out the endoscopy preparation sheet, the provider should enter patient details, note the preparation instructions provided to the patient, confirm that the patient understands the instructions, and document any pre-procedure assessments or evaluations.
The purpose of the endoscopy preparation sheet is to ensure patient safety by providing clear instructions, gathering pertinent patient information, and serving as a record of pre-procedure compliance.
The information reported on the endoscopy preparation sheet should include patient identification details, medical history relevant to the procedure, pre-procedure instructions provided, and confirmation of patient understanding and compliance.
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