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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 THE PATIENTS RESPONSIBILITY TO CONTACT THEIR 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: EGD (Upper Endoscopy) **Bring photo ID & Insurance card to appointment. Call our office to confirm your appointment 5 days prior to your appointment. **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 ones. Thank you. Patient Instructions for Morning/Mid-Afternoon Upper Endoscopy Procedures A driver will be required to drive you home NO TAXI CABS/NO SHUTTLE BUSES (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. 1. If you are taking Coumadin, Warfarin, or other blood thinners such as Plavix. We recommend stopping them 5 days prior to your appointment but you MUST check with your primary physician and/or your cardiologist before stopping these medications. ** If you require antibiotics prior to procedures please see your primary physician. #22003 (2/16) Side 1 Continued on back

2 2. One day prior to procedure: You may have normal meals. You should not eat or use tobacco in any form after your evening meal. You may drink water up to 6 hours prior to your procedure time. 3. Day of Procedure: DO NOT EAT BREAKFAST/NO SOLID FOODS DO NOT DRINK ANY FLUIDS (6) HOURS BEFORE If you are diabetic and take diabetes medication, please contact your primary care doctor or endocrinologist to discuss dosing of your insulin and/or oral diabetic medication. DO NOT take morning medications. Bring all prescription medications with you or a complete list with dosages and instructions along with any supplements. Please do not wear perfume or cologne. Wear loose fitting clothing and plan to be here for 2 hours. BRING PHOTO ID & INSURANCE CARD : 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: Park in the patient parking lot and proceed to the third floor Endoscopy Suite 320 What is an Upper Endoscopy? Upper endoscopy enables your doctor to examine the inside of your esophagus, stomach, and duodenum for sources of pain, bleeding, or abnormalities by using a flexible, fiber optic tube. The throat is numbed with a topical spray to help reduce gagging and IV sedation is usually used to help the patient relax. It takes less than 15 minutes, though you will be given time to recover from the sedative and should plan to be here 2 hours. If you require IV antibiotics or additional lab testing, you will need to allow more time for the visit. In preparation for your endoscopy. Please bring all medications you are taking (prescription, non-prescription, and herbal supplements) to your appointment. If you are on a blood thinning medication such as Coumadin, Plavix or Warfarin, or have a heart murmur, recent joint replacement, or stent placement, please make your healthcare provider aware of this before your endoscopy. Certain medications may need to be stopped temporarily prior to your procedure or antibiotics may need to be given. Please inform your healthcare provider if you are pregnant, have any health conditions or allergies -especially to latex or anesthesia. What are the possible complications of an upper endoscopy? Upper endoscopy is a safe procedure, with serious complications occurring less than 1% of the time. Complications can include aspiration, cardiac arrhythmia, fainting, and reactions to the medications used. A slightly irritated throat is not uncommon. You will be given written discharge instructions after your procedure that lists any symptoms to watch for. #22003 (2/16) Side 2

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)

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.

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