Welcome to MGH Gastroenterology Associates! Dear Patient, At MGH Gastroenterology Associates our goal is to welcome each patient to our practice and ensure they receive the very best care. Our collaborative practice of gastroenterologists, researchers, nurses and staff are dedicated to the prevention, diagnosis, treatment and management of digestive diseases. Possessing expertise in all aspects of digestive health, our multidisciplinary team of specialists offers patients the benefit of an individualized treatment plan. Our scheduling team invests a significant amount of time in coordinating your appointments. Missed appointments and late cancellations can pose problems for our office and may have possible health risks for you the patient, as well as for other patients who could have been seen if the appointment was made available. If you cannot make your scheduled appointment, please call our office to reschedule at least 5 days in advance so that we may accommodate other patients. Thank you for choosing Massachusetts General Hospital. We look forward to caring for you. Sincerely, MGH Gastroenterology Associates Did You Know? Colorectal cancer is the 3 rd most common type of cancer (excluding skin cancer) in men and women. For the average person, the lifetime risk of developing colorectal cancer is about 1 in 20 people (5%). This risk can be higher for people with certain risk factors. When found early, colorectal cancer is treatable and beatable. If everyone age 50 or older had a screening test, as many as 90% of deaths from colorectal cancer could be prevented.
GI Procedure Information: Appointment Time and Location Scheduled Procedure: Patient Name: Date and Arrival Time: Physician and Phone Number: Blake Building, 4 th Floor 55 Fruit Street, Boston, MA 02114 Parking: Fruit Street Garage or Parkman Street Garage Charles River Plaza, 9 th Floor 165 Cambridge St, Boston, MA 02114 Parking: Charles River Parking Garage 207 Cambridge Street or Fruit Street Garage or Parkman Street Garage Mass. General/North Shore 102-04 Endicott St., Danvers, MA 01923 Parking: Center for Outpatient Care Included in this Packet Pre-Procedure Checklist Preparation Instructions Medication and Medical History Form Consent to Procedure sample Contact Information If you have any questions, please contact your GI physician s office directly. It is very important that you keep this appointment. If you must cancel, please do so at least 5 days in advance. Please visit our website www.massgeneral.org/endoscopy for additional information and frequently asked questions.
Directions from Parking to Endoscopy Center For driving directions and more information, please visit the Parking & Visitor Information website at www.massgeneral.org/visit If you are using GPS, please be sure to verify the Zip Code Blake Building, 4th Floor 55 Fruit Street, Boston, MA 02114 From the Fruit Street Garage or Parkman Street Garage After parking, enter through the MGH Main entrance Take the E elevator to the 4th floor of the Blake Building Once you exit the elevator, look for the glass door labeled MGH GI Associates Charles River Plaza, 9th Floor 165 Cambridge Street, Boston, MA 02114 From the Charles River Plaza Parking Garage, 207 Cambridge Street (preferred parking location) Look for the orange wall labeled 165 Cambridge Street Take the elevator to the 9th floor The entrance will be on your left From the Fruit Street Garage or Parkman Street Garages Walk down North Grove Street, take a left onto Cambridge Street Walk 2 ½ blocks and you will see the sign for Charles River Plaza on your left The 165 Cambridge St. building will be on the right of the plaza -enter through the glass doors Elevators are at the end of the hallway, go to the 9th floor -the entrance will be on your left Mass General / North Shore 102-104 Endicott Street, Danvers, MA 01923 From the Center for Outpatient Care Parking Lot Enter through the Main Entrance Elevators straight Ahead Take Elevator to the 2 nd Floor
MGH Gastroenterology Associates 55 Fruit Street Boston, MA 02114-2696 Pre-Procedure Checklist: No sedation IMPORTANT- Please read these instructions at least 2 weeks before your examination and, please set up a Partners HealthCare Patient Gateway account, if you do not have one already. Pre-Procedure Checklist Please open a Patient Gateway account at massgeneral.org/mypatientgateway to update your medical record and to improve communication with your care team. Complete the Medication and Medical History Form. Update your MGH registration information by calling 866-211-6588. Call your medical insurance company for a referral if required by your insurance plan. Medications If you have diabetes and are instructed to not eat before the exam, ask your primary care physician about changes in the proper dose of diabetes medications: if you take insulin, we usually recommend you take ½ your normal dose the day of your exam. If you take blood thinners (Coumadin, Plavix, Pradaxa, Lovenox, etc.) we recommend you continue unless you have specifically been asked to stop by the GI physician performing your exam. Transportation You will not need an escort to take you home following your exam as you will receive no sedation. What to Bring to Your Endoscopy Exam Completed Medication and Medical History Form Bring photo identification. After Your Endoscopy In most cases, you will spend less than 3 hours in the Endoscopy Unit. We make every effort to perform your exam at the scheduled time but medical care can result in unavoidable delays. Revised 10/2016
MGH Gastroenterology Associates 55 Fruit Street Boston, MA 02114-2696 Anal Endoscopic Ultrasound Preparation Instructions IMPORTANT- Please read these instructions at least 1 day before your examination One (1) Day Before Your Exam Purchase 2 Fleet saline enemas. You do not need a prescription. Complete the Medication and Medical History Form Review Patient Consent to Procedure form. Day of Your Exam Take all of your usual medications. You can eat normally. One hour before leaving home for your exam, administer one Fleet s enema rectally. If you feel you have not completely cleared out your rectum, please take the second Fleet s enema 15 minutes after you have used the first one. After Your Procedure You may return to work after the procedure with no limitations. Revised 10/2016
GI Endoscopy Medication and Medical History Form NAME: DOB: Please complete the following worksheet regarding your medications and medical/surgical history. This information will assist the nurse during your admission process. ALLERGIES (Please list) MEDICATION LIST (Please list all medications that you are taking) Name of Medication Dose How often Last taken (date/time) Please list any over-the counter preparations (vitamins, supplements, cold medications, etc) Name of Medication Dose How often Last taken (date/time) Have you ever had any problems with anesthesia or sedation? Yes No Why are you having this procedure today?
GI Endoscopy Medication and Medical History Form Please check the box if you have any of the following medical problems: Gastrointestinal Cardiac Lung Neurological Mental Health Kidney Vascular Orthopedic Blood disorders Immune system Endocrine Cancer Other Have you had any of the following surgical procedures? Abdominal Yes No Pelvic Yes No Heart/Lung Yes No Transplant Yes No Other Yes No Is there anything else you would like us to know?
PATIENT IDENTIFICATION AREA PATIENT CONSENT TO PROCEDURE PATIENT: UNIT NO: PROCEDURE: Right Left Both Sides Not applicable My doctor has told me and I understand what procedure/surgery I am having done. I understand why I need it, the possible risks (like drug reactions, bleeding, infection, and complications from receiving blood or blood components), and that there is no guarantee of results. My doctor has also explained what might happen to me if I don t have this procedure, other choices I can make instead of having this done, (including choosing no treatment) and what can happen to me if I choose to do something else. I understand that with any procedure, problems could come up that we did not expect. My provider explained to me how he/she prevents infections related to my health. The following additional risks or issues were explained to me: If procedural sedation will be used during this procedure to control my pain, I understand that this method of pain control has risks. These risks include diffi culty breathing that may require breathing support and decreased blood pressure. The most common side effects are nausea and vomiting. In rare cases, there can be allergic reactions or cardiac arrest (stopping of the heart). Lastly, I may have pain, even after using these medications. My doctor and/or his/her associates on the Service will perform my procedure/surgery. I understand that Massachusetts General Hospital (MGH) is a teaching hospital. This means that resident doctors, doctors in a medical fellowship (fellows) and students in medical, nursing and related health care professions receive training here, and may take part in my procedure/surgery. A team of medical professionals will work together to perform my procedure/surgery. My doctor or an attending designee will be present for all the critical parts of the procedure/surgery, although other medical professionals may perform some aspects of the procedure as my doctor or the attending designee deems appropriate. I understand that this procedure/surgery may have educational or scientific value. The hospital may photograph, videotape, or record my procedure/surgery for educational, research, quality and other healthcare operations purposes. Any information used for these purposes will not identify me. I understand that blood or other samples removed during this procedure may later be thrown away by MGH. These materials also may be used by MGH, its partners, or affiliates for research, education and other activities that support MGH s mission. I have had the chance to ask questions about the risks, benefits and alternatives to this procedure/surgery. I am happy with the answers I received. I consent to this procedure/surgery. Date Time AM/PM Signature (patient/health care agent/guardian/family member) (If patient s consent cannot be obtained, indicate reason above.) I attest that I discussed all relevant aspects of this procedure/surgery, including the indications, risks, and benefits, as compared with alternative approaches, with the patient, and answered his/her questions. Date Time AM/PM Signature (Physician/Licensed Practitioner) 10465 (10/14)