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Microsoft word - dr. nargunds pre pro#17a39c.doc
PRE PROCEDURE INSTRUCTIONS
1. Please arrive a half hour before your scheduled procedure time.
2. Please bring with you the following:
• Your insurance card(s)• Some type of I.D. (i.e. driver’s license, work I.D., etc.)
3. You will need someone to drive you home.
4. *There is no eating or drinking 8 hrs before your procedure. *
• You may take you regular medications, such as pain
medication, blood pressure or heart medications with a sip of
• Please be sure to notify Dr.Nargund prior to your procedure
of any diabetes medications that you are currently taking.
5. You must stop taking any of the following FOUR days prior to
• All Anti-Inflammatory medications• Ibuprofen• Motrin• Advil• Aleve• Anaprox (naproxen sodium)• Ansaid (flurbiprofen)• Arthrotec (diclofenac, misoprostol)• Clinoril (sulindac)• Daypro (oxaprozin)• Dolobid (diflunisal)• Feldene (piroxicam)• Indocin (indomethacin)• Lodine (etocolac)• Mobic (meloxzicam)• Nalfon (fenoprofen)• Naprosyn (naproxen)• Orudis (ketoprfen)• Relafen (nabumetone)• Tolectin (tolmetin sodium)• Voltaren (diclofenac)
6. You must stop taking any of the following SEVEN to TEN days
prior to your procedure:
• Aspirin or any product that contains aspirin• Excedrin• Anacin• Bufferin• Aggrastat (tirofiban)• Aggrenox (dipyridamole and aspirin)• Acriptin• Coumadin (warfarin)• Doans (magnesium salicylate)• Fiorinal (buttalbital)• Halfprin• Lovenox (enoxaparin)• Persantine (dipyridamole)• Plavix (clopidogrel)• Pletal (cilostazol)• Trental (pentoxifylline)• Trilisate (choline magnesium trisalicylate)
7. PLEASE NOTE:
• Lovenox (enoxparin) must be stopped 24 hrs before your
• Ticlid (ticlopidine) must be stopped TWO WEEKS prior to
• Baby Aspirin must be stopped FOUR DAYS prior to your
*Please confirm this with your primary care physician.*
8. Please let our office know if your are allergic to any of the
• LATEX• Any type of STEROID.
• Any type of SHELLFISH (i.e. shrimp, lobster, etc.)• BETADINE• IODINE• CONTRAST DYE
* If you have any other allergies not list above or that our office
is unaware of. Please be sure to notify either Dr.Nargund or her
9. Please let our office know if you are on any antibiotics or have
10. You will be advised if a blood test is necessary before your
11. Please notify our office 24 hrs in advance of any cancellation.
12. If you have any concerns or questions please do not hesitate to
call our office at (201)487-7246.
PLEASE NOTIFY OUR OFFICE IMMEDIATELY IF YOU ARE
TAKING ANY OF THE ABOVE MENTIONED MEDICATIONS,
ANY HERBAL OR VITAMIN SUPPLEMENTS, ANY STERIOD
MEDICATION OR RECEIVED ANY OTHER TREATMENT
**Please note these precautions are taken for your safety.**
Thank you for your cooperation.
PRE - PROCEDURE INSTRUCTIONS
I ______________, have been made aware of the pre procedure
instructions for my upcoming procedure. I have had the
opportunity to ask questions which have been answered to my
satisfaction. I am signing this agreement, which will be placed
in my file.
I understand that these instructions apply to this procedure
and any other future procedures I may have at Bergen
Anesthesia Associates’ Pain Management Office unless
otherwise specified by my Pain Physician.
I will notify my Pain Physician of any new medications or new
medical problems prior to any procedure now and in the
future while I am under treatment in a prompt and timely
I will comply with the above instructions which have been set
forth. I am aware that these instructions have been given to me
for my safety.
Adventist Health Balance and Mobility Center 10201 SE Main Street Suite 4 Appointment Date:____________________________ Insurance:___________________________________ Portland OR 97216 (503) 251-6350 TIME IN:_______________ TIME OUT:_____________ Patient Questionaire Instructions : Please complete the questions as best as you can and bring with you on the day of your appoi
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