Outpatient Endoscopy Post-Procedure Instructions
Patient Name:
Date of Procedure:
Type of Procedure:
Physician:
Medications
Restart regular medications:
Special medication instructions:
Diet
When to begin eating/drinking:
Diet restrictions:
Activity
When to resume normal activities:
Activity restrictions:
Potential Symptoms
Call your physician or seek medical attention if you experience any of the following:
Follow-up
Appointment:
Results notification:
Additional Instructions
Patient Signature:
Date: