PRE-PROCEDURE INSTRUCTIONS:

Have your doctor complete and forward a Referral form for Capsule Endoscopy and Insurance information. He will also complete a Screening and a brief History worksheet along with the Consent Form signed by you. If you have any problems securing this, please call me (Eric) for assistance at 410.583.2614.

FIRST TIME AS A PATIENT AT HOPKINS?

We will need to assign a History Number for you to easily and accurately trace your patient records. You may provide this with the records completed by you and your physician or I can secure it from you personally, if preferred. In order to process this, we will need your:

1. NAME
2. SOCIAL SECURITY #
3. DATE OF BIRTH
4. SEX
5. RACE
6. MOTHER'S FULL MAIDEN NAME
7. FATHER'S FULL NAME
8. ADDRESS
9. TELEPHONE NUMBER

It is very important to have a "clean" small bowel for clear, non-obstructed images. Please follow the following instructions for optimum results.

DAY PRIOR TO THE PROCEDURE:
1. Light Breakfast, then, clear Liquids (drinks you can see through your glass) the rest of the day.
Drink ample amounts of water.
2. If tolerated, take one bottle of Magnesium Citrate (available over the counter at pharmacies) at 8pm.
3. Refrain from smoking 24 hours before your procedure.
4. Do not take anything by mouth after 10pm.
5. Do not take medication for 2 hours prior to your procedure (5am)
6. If your abdomen has hair, please shave an area 6 inches above and 6 inches below the navel in a square.
7. Wear loose fitting clothing, top and bottom, separate.
8. Come to the Green Spring Station (address and directions on main page) at 7:15am.

PROCEDURE:
1. A series of electrodes will be placed on your abdomen.
2. The electrodes will be attached to a data recorder that will be attached to your waist with a belt.
3. You will be asked to swallow the capsule (about the size of a large vitamin pill).
4. You may resume most daily activities after leaving the clinic.
5. Return at 3:30pm, unless the capsule passes earlier, to have the recorder removed.