Please call with any questions or scheduling concerns.

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Please call 952-442-8011 with any questions or scheduling concerns.

1 Please call with any questions or scheduling concerns. Gastroenterology Waconia Ridgeview Professional Building 560 South Maple Street, Suite 2 Pond Level Waconia, MN Chaska Two Twelve Medical 111 Hundertmark Road, Suite 320 Chaska, MN Shakopee St. Francis 1455 St. Francis Avenue Shakopee, MN IT IS PATIENT RESPONSIBILITY TO CONTACT YOUR INSURANCE COMPANY TO VERIFY COVERAGE & BENEFITS FOR THIS PROCEDURE. IF A PRIOR AUTHORIZATION IS REQUIRED BEFORE SERVICES RENDERED, PLEASE CONTACT YOUR PRIMARY CARE CLINIC FOR A REFERRAL TO BE SUBMITTED TO YOUR INSURANCE COMPANY. THANK YOU. Patient name: Date: Check in time: Physician: Procedure: Colonoscopy Please review the following instructions carefully to verify they are the correct instructions for your scheduled procedure. Please call our office if they are incorrect so we may send the correct one to you. Thank you. MIRALAX SPLIT PREP: Instructions for Morning/Mid-Afternoon Colonoscopy Procedures. 1. A driver will be required to drive you home (no driving, working or making any life altering decisions for 24 hours after procedure). Your driver must pick you up within 2 hours of dropping you off. 2. If you are taking Coumadin, Warfarin, or other blood thinners such as Plavix or Pradaxa, we recommend stopping those 5 days prior to your appointment but you need to check with your primary physician and/or your cardiologist before stopping these medications. 3. If you are diabetic and take diabetes medication, please contact your primary care provider or your endocrinologist to discuss dosing of your insulin and/or oral diabetic medications prior to the procedure. This may need to be adjusted due to the modified diet one day prior to procedure. *If you require antibiotics prior to procedures contact your primary physician. #22006 (2/16) Side 1 Continued on back

2 4. Please purchase the following non-prescription items from your pharmacy at least 2 days prior to your exam: MIRALAX 238 GRAM BOTTLE OF POWDER, 4(FOUR) Dulcolax LAXATIVE TABLETS- 5mg tablets (Can be generic brand- Bisacodyl), You will also need 64 ounces of a clear liquid to mix with the Miralax. Such as: Gatorade, lemonade, water no red coloring 5. FIVE (5) days prior to the procedure: Begin a low a low fiber diet SOME RECOMMENDED LOW FIBER OPTIONS: Potatoes, wheat or white bread (no nuts or whole wheat products), English muffins or bagels, low fiber cereal, soda crackers, pasta, canned fruits or fruits without peels, cooked vegetables, fruit juices, rice, low fat meats and dairy products. AVOID: whole grains, fresh fruits or raw vegetables, beans, raisins, berries, nuts, popcorn. 6. ONE DAY PRIOR TO PROCEDURE: Clear liquids (nothing red) all day. NO Solid foods. Recommended Clear Liquids: Gatorade, Propel, Vitamin water, apple, white grape, white cranberry juice, non-diet pop, Kool-Aid, Hi-C or other sport drinks, fruit juice without pulp, soup bouillon, jell-o, popsicles, gummy bears, small amounts of tea or coffee without creamer, Pedialyte, Crystal light. Be sure to drink plenty of water though out the day and a good variety of all the listed clear liquid products. AVOID: Dairy products, large amount of caffeinated products and large quantities of carbonated beverages 3PM: Take 4(four) bisacodyl laxative tablets with 8 ounces of water (may be taken earlier in the day if you plan to be home) 5PM: Mix the entire bottle of Miralax with 64 ounces of clear liquid and shake/stir well. Drink half of the mixture (32ounces). Drink an 8 ounce glass every 15 minutes until you have consumed 32 ounces. If you become nauseous, take a minute break and then resume drinking prep. Continue drinking clear liquids for remainder of evening. 7. Day of Procedure: AT 5:00AM you will need to drink the remaining 32 ounces of the prep. Drink an 8 ounce glass every 15 minutes until it is gone. ***If your procedure has a check in time before 9:00am then you can choose to drink the entire prep (all 64oz.) the night before Continue drinking clear liquids until 2 hours prior to procedure. A responsible driver will be required to drive you home (no driving, working or making any life altering decisions for the remainder of that day). Your driver must pick you up within 2 hours of dropping you off. You will not be able to use a cab or public transportation. : WACONIA: Ridgeview Professional Building. Park in MAIN LOT located across from MAIN entrance of the hospital. Take the elevator down to POND LEVEL(-2 floor) Endoscopy Dept. on your left. CHASKA: 212 Medical Building. Park in the patient parking lot and proceed to the third floor ENDOSCOPY DEPARTMENT, Suite 320. BRING PHOTO ID, MED LIST & INSURANCE CARD WITH TO APPOINTMENT #22006 (2/16) Side 2

500 South Maple Street Waconia MN 55387 (952) 442-2191 Getting to Ridgeview Medical From Minneapolis: Take I-35W south to Hwy. 62 west, and Hwy. 62 west to Hwy. 212/5 west. This will turn into Hwy.

From the North: Take I-494 south to Hwy. 5 west. Continue on Hwy. 5 west through Eden Prairie, Chanhassen and Victoria. Once in Waconia (still on Hwy.

3 500 South Maple Street Waconia MN (952) Getting to Ridgeview Medical From Minneapolis: Take I-35W south to Hwy. 62 west, and Hwy. 62 west to Hwy. 212/5 west. This will turn into Hwy. 5 west. Continue on Hwy. 5 west through Eden Prairie, Chanhassen and Victoria. Once in Waconia (still on Hwy. 5) look for South Maple Street (1 block after third set of lights on Hwy. 5). Turn right onto South Maple Street. From the North: Take I-494 south to Hwy. 5 west. Continue on Hwy. 5 west through Eden Prairie, Chanhassen and Victoria. Once in Waconia (still on Hwy. 5) look for South Maple Street (1 block after third set of lights on Hwy. 5). Turn right on South Maple Street. From the South: Take Hwy. 169 north to Hwy. 41 north. Take Hwy. 41 north to Hwy. 5 west. Take Hwy. 5 west through Victoria. Once in Waconia (still on Hwy. 5) look for South Maple Street (1 block after third set of lights on Hwy 5). Turn right on South Maple Street. From the East: Take I-494 west to Hwy. 5 west. Take Hwy. 5 west through Eden Prairie, Chanhassen and Victoria. Once in Waconia (still on Hwy. 5) look for South Maple Street (1 block after third set of lights on Hwy. 5). Turn right on South Maple Street. From the West: Take Hwy. 5 east to Waconia. Upon entering Waconia, look for South Maple Street. Take a left on South Maple Street. 111 Hundertmark Road Chaska MN (952) Getting to Two Twelve Medical From Minneapolis: Take I-35W south to Hwy. 62 west. Continue on Hwy. 62 west to Hwy. 212/5 west. This will turn into Hwy. 5 west. Continue on Hwy. 5 west, veering to the left on the new Hwy Exit on Hwy. 41 and turn right (north). Turn right on Hundertmark Road. Two Twelve Medical is located on your right, at 111 Hundertmark Road. From the North: Take I-494 south to Hwy. 5 west. Continue on Hwy. 5 west, veering to the left on the new Hwy Exit on Hwy. 41 and turn right (north). Turn right on Hundertmark Road. Two Twelve Medical is located on your right, at 111 Hundertmark Road. From the South: Take Hwy. 169 north to Hwy. 41 north. Continue north on Hwy. 41 and turn right on Hundertmark Road, which is just north of Hwy Two Twelve Medical is located on your right, at 111 Hundertmark Road. From the East: Take I-494 west to Hwy. 5 west, veering to the left on the new Hwy Exit on Hwy. 41 and turn right (north). Turn right on Hundertmark Road. Two Twelve Medical is located on your right, at 111 Hundertmark Road. From the West: Take Hwy. 212 east. Exit on Hwy. 41 and turn left (north). Turn right on Hundertmark Road. Two Twelve Medical is located on your right, at 111 Hundertmark Road. #22001 (2/16)

Turn left onto Marschall Rd; continue south approximately 1/2 mile. The campus is located on the left side of the road.

4 Driving Directions and Map to St. Francis Regional Medical From Minneapolis Take I-35W southbound to Hwy 13 south/shakopee exit. Hwy 13 intersects with Hwy 101; take Hwy 101 to Hwy 169 south/mankato exit; continue on Hwy 169 south to Marschall Rd (County Rd. 17) exit. Turn left onto Marschall Rd; continue south approximately 1/2 mile. The campus is located on the left side of the road. From the north Take I-494 southbound and exit on Hwy 169 south; continue on Hwy 169 south across the Minnesota River; continue on Hwy 169 south to Marschall Rd (County Rd. 17) exit. Turn left onto Marschall Rd; continue south approximately 1/2 mile. The campus is located on the left side of the road. From the south Take Hwy 169 north; continue north on 169 past Shakopee exit to Marschall Rd (County Rd. 17) exit. Turn right onto Marschall Rd; continue south approximately 1/2 mile. The campus is located on the left side of the road. From the east Take Hwy 13 west from Burnsville. Hwy 13 intersects with Hwy 101; take Hwy 101 to Hwy 169 south/ Mankato exit; continue on Hwy 169 south to Marschall Rd (County Rd. 17) exit. Turn left onto Marschall Rd; continue south approximately 1/2 mile. The campus is located on the left side of the road. From the west Take Hwy 5 and turn south on Hwy 41 in Chanhassen. Take Hwy 41 through Chaska to Hwy 169 intersection; turn left and go north on 169; continue north on 169 past Shakopee exit to Marschall Rd (County Rd. 17) exit. Turn right onto Marschall Rd; continue south approximately 1/2 mile. The campus is located on the left side of the road. Valley Fair Savage Canterbury Park 1455 St. Francis Avenue Shakopee, MN Jordan To Belle Plaine Mystic Lake Prior Lake

5 North Entrance to Emergency 17th Ave E Temporary Hospital Entrance ê Orange Lot ONE WAY ONE WAY HOSPITAL STAFF Red Lot PATIENT & PHYSICIAN PATIENT DROP-OFF AND PICK-UP Green Lot Marschall Rd/ County Rd 17 EMERGENCY OPEN 24/7 Patient and ê employee entrance HOSPITAL AND CLINIC STAFF Purple Lot New Entrance CANCER CENTER 1475 ST FRANCIS REGIONAL MEDICAL CENTER 1455 PARK NICOLLET CLINIC 1415 CLOSED for construction MEDICAL OFFICE BUILDING 1515 ALL CLINIC PATIENT ST GERTRUDE S HEALTH & REHABILITATION CENTER Gray Lot EMPLOYEE ENTRANCES St. Francis Ave HOSPITAL STAFF Blue Lot ALLINA HEALTH CLINIC & ORTHOPEDIC/ NEUROSCIENCE CTR 1601 ê Entrance for all clinics Sarazin St Brown Lot ADDITIONAL CLINIC PATIENT St. Gertrude s, staff for 1515 & 1601 medical office bldg. Valley View Rd E CONSTRUCTION/VENDOR & OVERFLOW PA RKING S Patient parking Staff parking 11/15 St. Francis Regional Medical Campus Map

6 Temporary Main Hospital Entrance FIRST FLOOR Support Human Resource ê Patient drop-off and pick-up North Entrance (open 4 am to 8 pm) Guest Patient Staff North (Orange Lot) Cancer Conference Atrium Legacy Café (Cafeteria) Care North Elevator Cancer Entrance (open 4 am to 8 pm) Emergency Entrance open 24/7 Cancer Surgery Temporary patient registration Administration MRI Chapel Laboratory Emergency CT Scan Mammography Ultrasound X-Ray Imaging Care South Elevator St. Francis Health Clinic To St. Gertrude s Emergency (Red Lot) Park Nicollet Clinic CPAP Optical Patient Registration Phone 1515 Medical Office Building To 1601 Medical Office Building S Hospital & Clinic Main Entrance (CLOSED for construction) Clinic Patient All clinic patients enter through 1601 Medical Office Building

Please call with any questions or scheduling concerns.

Please call with any questions or scheduling concerns. Please call 952-442-8011 with any questions or scheduling concerns. Gastroenterology Waconia Ridgeview Professional Building 560 South Maple Street, Suite 2 Pond Level Waconia, MN 55387 Chaska Two Twelve