Microsoft word - pc513 - procedure scheduling information.doc
Lakeview Pain Management Center 520 East Medical Drive, Suite 100, Bountiful, UT 84010 Procedure Scheduling Information You are scheduled for the following procedure(s):
1. _________________ at _______________ for _____________________________________
2. _________________ at _______________ for _____________________________________ date
3. _________________ at _______________ for _____________________________________ date
4. _________________ at _______________ for _____________________________________ date
1. If you are pregnant or have missed your menstrual cycle, notify us as soon as possible.
2. If you are having an epidural, nerve root injection, transforaminal injection, caudal injection or rhizotomy (RF-
radiofrequency), you must have a responsible adult (18 years or older) drive you home.
3. If you are planning to receive sedation medication during your procedure:
a. You must arrange to have a responsible adult (18 years or older) drive you home. For your safety, we do
not want you to drive yourself that day. If you don’t have a driver, we regret we will have to reschedule your procedure.
b. Take all of your routine medications, including your usual pain medications, unless told otherwise, with
c. You may not eat or drink anything (other than your medications) 4 hours before the procedure. For your safety, if you have eaten, we will need to withhold sedation.
d. If you are a diabetic and are scheduled for a morningprocedure: DO NOT eat breakfast and do not take
your diabetes pill. If you are taking insulin, take only half of your usual long-acting dose and do not take any short-acting insulin. After your procedure, you may eat as usual and resume your medications.
e. If you are a diabetic and are scheduled for an afternoon procedure: have breakfast before 6:00 AM, take
your usual morning insulin dose, but in the afternoon take only 1/2 your usual long-acting dose and do not take short-acting insulin. After your procedure, you may eat as usual and resume your normal medications.
4. If you are having a cervical rhizotomy, epidural, nerve root injection, transforaminal injection, caudal injection, spinal
cord stimulator or pump implant procedure, and you are taking aspirin, arthritis medications or "blood thinning" anticoagulant medications, either by prescription or over-the-counter, please notify Dr. Garg at 801-299-6824 as soon as possible to avoid delays in scheduling your procedure.EXAMPLES:
Non-steroidal anti-inflammatory drugs (NSAIDs):ibuprofen (Motrin, Advil, Nuprin), Naprosyn, Ansaid, Aleve, Mobic, Relafen, Lodine, Daypro, Feldene, Disalcid, Voltaren, Orudis, Cataflam, Clinoril, Dolobid, Trilisate, Toradol, Indocin, Arthrotec.
Herbal drugs: ginger, garlic, ginko, fish oil
BC powder, Darvon compound, Talwin compound, Norgesic, Norgesic Forte, Soma Compound, Percodan, Fiorinal
Aspirin containing drugs: Excedrin, baby aspirin, regular strength aspirin
Anticoagulant drugs: Coumadin, Ticlid, Plavix, persantine, Aggrenox, Lovenox, heparin, Fragmin, Argatroban, Reopro, Trental
5. If you are unable to keep your scheduled appointment(s), call 801-299-6824 within 24 hours prior to the appointment
6. Please check in at Same Day Surgery located on the south end of Lakeview
PC513 7.27.2011 Loop – Pain Clinic Page 1 of 1
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