3 Patient Information OG 2019-01-17T07:14:30+00:00

Patient Information

FOR NEW PATIENT’S VISITING OUR CLINIC

We recommend that you review and fill out applicable forms below, especially the Patient Information Form (PIF). If you fill out the paper version of the PIF, please bring it with you on your first visit to our clinic. This form allows us to enter basic information about your health history and will expedite your visit.

Patient Interview Form (Timesaver)
GERD Questionnaire Form (Timesaver)
GI EXCELLENCE FORMULARIO DE PREGUNTA DE GERD
Assessment Colorectal Cancer Prevention
HIPAA Notice of Privacy Practices
AVISO HIPAA DE PRÁCTICAS DE PRIVACIDAD
Patient Rights and Privacy
Derechos y Privacidad de Los Pacientes de GI Excellence
Office Policy and Procedure
Authorization for Release and/or Disclosure Information Form (For Patients Only)

PRE-PROCEDURE PREPARATIONS

The following procedure preparations are to be taken ONLY when you have a scheduled procedure appointment. Please do not perform any of the below preparations for a consultation clinic visit.

BRAVO® pH Monitoring

A small capsule, about the size of a gel cap, is
temporarily attached to the wall of the esophagus during an upper endoscopy. The capsule measures pH levels in the esophagus and transmits readings by radio telecommunications to a receiver (about the size of a pager) worn on your belt or waistband.

More Info
Más Información

IF YOU ARE HAVING AN UPPER ENDOSCOPY AND/OR ENDOSCOPIC ULTRASOUND

Prep Form
formulario de preparación
Consent Form
formulario de consentimiento

IF YOU ARE HAVING A COLONOSCOPY AND / OR RECTAL EUS

Over the counter colonoscopy preparation instructions preferred

Prep Form MiraLAX / Gatorade / Crystal Light (Recommended as a 1st choice)
Prep Form Magnesium Citrate (Recommend as a 2nd choice)
Prep Form Half-Lytely or Golytely (Requires prescription)
Consent Form
Formulario de Consentimiento

IF YOU ARE HAVING A VIDEO CAPSULE ENDOSCOPY:

Video Capsule Endoscopy
ENDOSCOPIA POR CAPSULA DE VIDEO
Patient Instructions for Pillcam® Small Bowell Capsule Endoscopy with the Sensorbelt
Informed Consent for Video Endoscopy

OTHER PATIENT CONSENT FORMS

All patients must review and sign the consent to their respective procedure. The consent for EGD, EUS, Colonoscopy and Rectal EUS is on the same form and outlines the risks of the procedure. The consent for ERCP and internal Hemorrhoid Therapy are on separate forms. Please review the appropriate consent form for your procedure prior to arriving to your a scheduled procedure.

GASTROINTESTINAL ENDOSCOPY PROCEDURES

Esophagogastroduodenoscopy (EGD)

Consent Form
FORMULARIO DE CONSENTIMIENTO

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAM (ERCP) NO FOOD AFTER MIDNIGHT.

Consent Form
FORMULARIO DE CONSENTIMIENTO

PRESCRIPTION REFILLS

GI Excellence physicians are available to authorize prescription renewals for our patients when appropriate. If you need a prescription refi ll call: (951) 652-2252.

DIET PLANS

If you have been recommended a special diet due to your condition, please download the appropriate diet guideline for your review.

Heartburn / Gastroesophageal Reflux Disease (GERD) Diet
High Fiber Diet
Dieta de Alta Fibra
Low Fiber or Low Residue Diet
dieta baja en fibra
Nutrition Guidelines for Patients with an Enteral Stent Diet
Pautas nutricionales para pacientes con stent enteral
Celiac Disease or a Gluten Free Diet
Enfermedad celíaca o una dieta libre de gluten

INSURANCE PROVIDERS

GI Excellence is a participating provider in most health insurance plans. If you have any questions about coverage, please call our office or your insurance company for information. Please contact your insurance and see if our healthcare providers are covered.

MANAGED CARE PLANS ACCEPTED

GI Excellence participates in most health insurance plans. We also accept Medicare and Cash paying patients.

Make An Appointment

Emphasizing endoscopy excellence, we give our patients the comfort of clarity.

BOOK AN APPOINTMENT