Dr. DamianosColonDr. EpsteinOur Friendly StaffECRPDr. ClarkA Video Capsule


Please follow these instructions exactly as given!

 

EMS Instructions

  • Nothing to eat after midnight.
  • If you are scheduled for an afternoon procedure, you

may have clear liquids such as broth, pulp-free juice,

sorbet, Popsicles®, Jello®, black tea/coffee, soda, hard candy

and Crystal Light® until four (4) hours prior to exam.

  • You may drive yourself home after the procedure.
  • Report to the Admitting / Outpatient / Short Stay Department at

________________________________ Hospital on

________________________ at ____________ AM/PM.

 

Clear Liquid Diet
(Do not eat or drink anything red or purple)

Broth Sorbet (with no fruit pieces)
Popsicles ® Jell-O ®
Water Black Tea/Coffee (No milk or cream)
Soda  Crystal Light ®
Hard Candy
Fruit Juice without Pulp White Grape Juice
White Grape Juice Apple Juice
Grapefruit Juice w/o pulp 
Gatorade ® / Sport Drinks

NOTE: Gatorade® or sports drinks result in better hydration than water alone.

 

rev 7/2/08 Form 112/212

If you have any questions, please call our offices at:
Somersworth (603) 692-2228; Portsmouth (603) 433-2488