EGD (Upper Endoscopy)

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Gastroenterology EGD (Upper Endoscopy) REMINDER FOR: ON THE DAY OF YOUR PROCEDURE Bring a list of all your medications (over-the-counter and prescription) You must have a driver to take you home following the procedure (if you do not have someone to drive you home, your procedure will be rescheduled to another day) Bring your Insurance Card and Photo ID PARKING: CHASKA: Two-Twelve Medical Center Park in the patient parking lot and proceed to the third floor ENDOSCOPY DEPARTMENT Suite 320 WACONIA: Ridgeview Professional Building Park in the MAIN PARKING LOT located across from the MAIN ENTRANCE of the hospital. Take the elevator down to the POND LEVEL (-2 floor) ENDOSCOPY DEPARTMENT Suite 2 ARLINGTON: Ridgeview Sibley Medical Center Arrive at the ER doors and check in at the nurses station LE SUEUR: Ridgeview Le Sueur Medical Center Park in the outpatient clinic lot, arrive through doors with large canopy and check in at registration #22009 (1/18)

Please call 952 442 8011 with any questions or scheduling concerns. Gastroenterology Waconia Chaska Arlington Le Sueur Ridgeview Professional Building Ridgeview Endoscopy Suite 560 South Maple Street Suite 2 Pond Level (-2) Waconia, MN 55387 Two Twelve Medical Center 111 Hundertmark Road Suite 320 Chaska, MN 55318 Ridgeview Sibley Medical Center 601 West Chandler Street Arlington, MN 55307 *Arrive at the ER doors and check in at the nurses station Ridgeview Le Sueur Medical Center 621 S. 4 th Street Le Sueur, MN 55318 IT IS THE PATIENTS RESPONSIBILITY TO CONTACT YOUR INSURANCE COMPANY TO VERIFY COVERAGE & BENEFITS FOR THIS PROCEDURE. IF A PRIOR AUTHORIZATION IS REQUIRED BEFORE SERVICES RENDERED, PLEASE CONTACT YOUR PRIMARY CARE CLINIC FOR A REFERRAL TO BE SUBMITTED TO YOUR INSURANCE COMPANY. THANK YOU. Patient Name: Date: Check In Time: Physician: Dr. Sabina Khan Dr. Brian Gootzeit Dr. Mustafa Tiewala Procedure: EGD (Upper Endoscopy) Patient Instructions for Morning/Mid-Afternoon Upper Endoscopy Procedures *A driver will be required to drive you home. No Taxi s or shuttle services. No driving, working or making any life altering decisions for 24 hours after procedure. Your driver must pick you up within 2 hours of dropping you off. *If you are taking Coumadin, Warfarin, or other blood thinners such as Plavix or Pradaxa, we recommend stopping those 5 days prior to your appointment but you need to check with your primary physician and/or your cardiologist before stopping these medications. *If you are diabetic and take diabetes medication, please contact your primary care provider or your endocrinologist to discuss dosing of your insulin and/or oral diabetic medications prior to the procedure. This may need to be adjusted due to the modified diet one day prior to procedure. *If you require antibiotics prior to procedures contact your primary physician. *You may take essential medications with a small sip of water by 5 AM the morning of your procedure. Wait to take nonessential medications until after your procedure. *Please arrive at your scheduled check in time. *Wear loose clothing and refrain from wearing fragrances #22003 (1/18) Side 1

Upper Endoscopy(EGD) Preparation: 1. One day prior to procedure: You may eat normal. You should not eat or use tobacco in any form after 7 PM the night before your procedure. You may drink clear liquids up to 6 hours prior to your procedure time. You may take your essential medications by 5 AM the morning of your procedure. Wait to take nonessential medications after your procedure is over. Recommended Clear Liquids: Gatorade, Propel, Vitamin water, apple, white grape, white cranberry juice, non-diet pop, Kool-Aid, Hi-C or other sport drinks, fruit juice without pulp, soup bouillon, jell-o, popsicles, gummy bears, small amounts of tea or coffee without creamer, Pedialyte, Crystal light. Be sure to drink plenty of water though out the day and a good variety of all the listed clear liquid products. AVOID: Dairy products, large quantities of caffeinated products and carbonated beverages 2. Day of Procedure: DO NOT EAT BREAKFAST/NO SOLID FOODS DO NOT DRINK ANY FLUIDS (6) HOURS BEFORE Refrain from wearing cologne or perfume Wear loose fitting clothing and plan to be here for 2 hours Remember to arrange a responsible driver. They must pick you up within 2 hours of dropping you off. Bring your medication list, insurance card and photo ID. What is an Upper Endoscopy? Upper endoscopy enables your doctor to examine the inside of your esophagus, stomach, and duodenum for sources of pain, bleeding, or abnormalities by using a flexible, fiber optic tube. The throat is numbed with a topical spray to help reduce gagging and IV sedation is used to help the patient relax. The procedure typically takes 15 minutes, though you will be given time to recover from the sedative and should plan to be here 2 hours. If you require IV antibiotics or additional lab testing, you will need to allow more time for the visit. In preparation for your endoscopy Please bring all medications you are taking (prescription, non-prescription, and herbal supplements) to your appointment. If you are on a blood thinning medication such as Coumadin, Plavix or Warfarin, or have a heart murmur, recent joint replacement, or stent placement, please make your healthcare provider aware of this before your endoscopy. Certain medications may need to be stopped temporarily prior to your procedure or antibiotics may need to be given. Please inform your healthcare provider if you are pregnant, have any health conditions or allergies -especially to latex or anesthesia. What are the possible complications of an upper endoscopy? Upper endoscopy is a safe procedure, with serious complications occurring less than 1% of the time. Complications can include aspiration, cardiac arrhythmia, fainting, and reactions to the medications used. A slightly irritated throat is not uncommon. You will be given written discharge instructions after your procedure that lists any symptoms to watch for. #22003 (1/18) Side 2

500 South Maple Street Waconia MN 55387 (952) 442-2191 Getting to Ridgeview Medical Center From Minneapolis: Take I-35W south to Hwy. 62 west, and Hwy. 62 west to Hwy. 212/5 west. This will turn into Hwy. 5 west. Continue on Hwy. 5 west through Eden Prairie, Chanhassen and Victoria. Once in Waconia (still on Hwy. 5) look for South Maple Street (1 block after third set of lights on Hwy. 5). Turn right onto South Maple Street. From the North: Take I-494 south to Hwy. 5 west. Continue on Hwy. 5 west through Eden Prairie, Chanhassen and Victoria. Once in Waconia (still on Hwy. 5) look for South Maple Street (1 block after third set of lights on Hwy. 5). Turn right on South Maple Street. From the South: Take Hwy. 169 north to Hwy. 41 north. Take Hwy. 41 north to Hwy. 5 west. Take Hwy. 5 west through Victoria. Once in Waconia (still on Hwy. 5) look for South Maple Street (1 block after third set of lights on Hwy 5). Turn right on South Maple Street. From the East: Take I-494 west to Hwy. 5 west. Take Hwy. 5 west through Eden Prairie, Chanhassen and Victoria. Once in Waconia (still on Hwy. 5) look for South Maple Street (1 block after third set of lights on Hwy. 5). Turn right on South Maple Street. From the West: Take Hwy. 5 east to Waconia. Upon entering Waconia, look for South Maple Street. Take a left on South Maple Street. 111 Hundertmark Road Chaska MN 55318 (952) 361-2447 Getting to Two Twelve Medical Center From Minneapolis: Take I-35W south to Hwy. 62 west. Continue on Hwy. 62 west to Hwy. 212/5 west. This will turn into Hwy. 5 west. Continue on Hwy. 5 west, veering to the left on the new Hwy. 212. Exit on Hwy. 41 and turn right (north). Turn right on Hundertmark Road. Two Twelve Medical Center is located on your right, at 111 Hundertmark Road. From the North: Take I-494 south to Hwy. 5 west. Continue on Hwy. 5 west, veering to the left on the new Hwy. 212. Exit on Hwy. 41 and turn right (north). Turn right on Hundertmark Road. Two Twelve Medical Center is located on your right, at 111 Hundertmark Road. From the South: Take Hwy. 169 north to Hwy. 41 north. Continue north on Hwy. 41 and turn right on Hundertmark Road, which is just north of Hwy. 212. Two Twelve Medical Center is located on your right, at 111 Hundertmark Road. From the East: Take I-494 west to Hwy. 5 west, veering to the left on the new Hwy. 212. Exit on Hwy. 41 and turn right (north). Turn right on Hundertmark Road. Two Twelve Medical Center is located on your right, at 111 Hundertmark Road. From the West: Take Hwy. 212 east. Exit on Hwy. 41 and turn left (north). Turn right on Hundertmark Road. Two Twelve Medical Center is located on your right, at 111 Hundertmark Road. 601 West Chandler Street Arlington MN 55307 (507) 964-2271 Getting to Sibley Medical Center From the North: Take Highway 5 south to Arlington. Turn right onto W. Chandler Street. Take the first right into the parking lot. From the South: Take Highway 5 northeast to Arlington. Turn left onto W. Chandler Street. Take the first right into the parking lot. From the West: Take Highway 19 to Gaylord. Turn right onto Main Ave. E / Highway 5. Take Highway 5 northeast to Arlington. Turn left onto W. Chandler Street. Take the first right into the parking lot. Or, take Highway 212 East to Highway 22 and turn right (south) on Highway 22. Take Highway 22 to Gaylord. Turn left onto Main Ave E / Highway 5. Take Highway 5 northeast to Arlington. Turn left onto W. Chandler Street. Take the first right into the parking lot. From the East (Henderson): Take Highway 19 west to 391st Ave / County Rd 17. Turn right onto 391st Ave / County Rd 17. Take 391st Ave / County Rd 17 north to Arlington. Once in Arlington, 391st Ave / County Rd 17 becomes 4th Ave E. Take 4th Ave E to Highway 5. Turn left on Highway 5. Turn right onto W. Chandler Street. Take the first right into the parking lot. #22001 (3/17)