You are having a colonoscopy on ______/______ /______.
Here are some ideas for what you can eat the day before.
**PLEASE—No red or purple
uids, pops, or jell-O!
Drink at least one 8oz. glass of clear liquid every 2 hours.
Clear Liquid Diet Sample Menus
BREAKFAST:
MID-MORNING SNACK:
LUNCH:
DINNER:
Clear juice
(Apple, White Grape)
Clear juice
(Apple, White Grape)
Jell-O
(NOT red or purple)
Jell-O
(NOT red or purple)
Jell-O
(NOT red or purple)
Ice Pop
(NO pulp, NOT red
or purple)
Ice Pop
(NO pulp, NOT red
or purple)
Italian Ice
(NOT red or purple)
Clear Broth
(beef, chicken,
or vegetable)
Clear Broth
(beef, chicken,
or vegetable)
Black Tea
Black Tea
Black Coee
Black Coee
Clear Soda Gatorade
(NOT red or purple)
Water
Water
AND
AND
AND
AND
AND
AND
AND
OR
OR OR OR
OR OR
OR
4
4
Date: _______________________
It is okay to have clear liquids up to 4 hours before your procedure. For example, if your exam is
scheduled for 10am, you can have clear liquids unl 6am. It’s VERY important to follow these direc-
ons. If you don’t, Anesthesia may cancel your procedure. Or they may delay your exam unl it’s
safe for you to have the procedure.
_______ Procedure Time
_______ Nothing to eat or drink aer this me
For 24 hours aer your procedure,
You may not drive
You may not operate equipment (lawnmower, snow blower, ATV, snowmobile)
You may not sign important documents
You may have a light meal aer your colonoscopy
1. Drink at least 8, 8 ounce glasses of clear liquids. This is important for keeping your kidneys
healthy.
2. If you had a biopsy and are having a lot of bleeding, call the doctor right away.
3. If the doctor removed a polyp, you may need to see the doctor in 7-10 days.
** Special Medicaon Instrucons for Day of Your Colonoscopy
The nurse who did your pre-op phone call told you which meds to take the morning of your colonos-
copy. Write which meds you should/should not take.
Take These Meds
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
Do Not Take These Meds
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
Day of Your Colonoscopy
Day Aer Your Colonoscopy
Lileton Regional Healthcare | 600 St. Johnsbury Road, Lileton, NH 03561
603.444.9000 | liletonhealthcare.org
Date: _______________________
1
1
Geng Ready for Your Colonoscopy at LRH
Quesons or Concerns?
You may call:
Same Day Surgery
603-444-9264
603-259-7797
Dr. Anthony Colacino’s oce
603-444-0997
You are having a colonoscopy at Lileton Regional Healthcare (LRH) with Dr. Anthony Colacino
on ___________________________ ______/_____ /_____
This is a procedure in which your doctor uses a scope to look at your enre large intesne.
It’s very important to follow these instrucons. We rely on you to clean your colon before-
hand. If your colon is not clean, your doctor will have a hard me seeing it. Then, you might
have to return for another colonoscopy.
