Dear Patient:

We ask that you please arrive 15 minutes prior to your appointment so that you may REGISTER directly in the RADIOLOGY DEPARTMENT. When you enter the front entrance of the hospital, this will be the first door on your left.

Child Preparations -

Birth - 1 yr.: Nothing to eat or drink 1 hr. before examination.

1 yr. - 13 yr.: If the examination is to be of greatest value, PLEASE make certain that the directions are followed exactly and the child take only the medication, food and water at the times shown.

TIME DIRECTIONS

12:00 NOON Child eats only the following:
1 cup of bouillon soup with crackers
1 chicken or turkey white meat sandwich with no
additives (ex: butter, mayonnaise)
1/2 glass of clear apple or grape juice
1 serving of plain jello with no additives (ex: milk
cream, fruit)
1 glass of skim or non-fat dry milk

1:00 PM Child drinks 1 full glass of water if possible.

3:00 PM Child drinks 1 full glass of water if possible.

5:00 PM Child eats only the following:
1 cup of bouillon soup (no crackers)
1 glass of clear apple juice or grape juice
1 serving of plain jello with additives

7:00 PM Child drinks 1 full glass of water if possible.

8:00 PM Magnesium Citrate (cold) - amount shown as appropriate for child's age.

AGE Mag Citrate AGE Mag Citrate

0-1 yr. NONE 7-9 yrs. 4 oz.
1 yrs. 1 oz. 9-10 yrs. 5 oz.
2 yrs. 1 1/2 oz. 11-12 yrs. 6 oz.
3-4 yrs. 2 oz. 13 yrs. 8 oz.
4-6 yrs. 3 oz. 14 yrs. 11 oz.

10:00 PM Dulcolax Tablets - with 1 full glass of water as appropriate for child's age. Tablets must be swallowed whole, not chewed or crushed.

AGE Dulcolax Tablets

0-3 yr. NONE
4-6 yrs. 1 tablet (whole if possible)
7-13 yrs. 2 tablets
14 yrs. 3 tablets

6:30 AM Dulcolax Suppository - wrapped and administered as follows:

AGE Dulcolax Suppository

0-1 yrs. NONE
1-9 yrs. 1/2 suppository
9-14 yrs. 1 whole suppository

1. Cut in half, if half suppository is to be used.
2. With child lying on left side, with right thigh
raised, insert suppository into the child's
rectum, making sure some portion of the
suppository touches the wall of the rectum.
3. Close the child's thighs to help the child
retain suppository.
4. Try to keep the suppository in for 15-20 minutes
Bowel movements will occur in 15 minutes to 1
hour.
5. For children who need assistance, a bedpan,
commode or aid to bathroom must be made
available.

If you have any questions regarding your exam or the preparation, please feel free to call us at 298-2277, #1.

WE REQUIRE YOUR PRESCRIPTION FOR THIS TEST TO ENSURE WE TAILOR THE EXAM TO ANSWER YOUR MEDICAL PROBLEMS. IF YOUR PHYSICIAN HAS NOT GIVEN ONE TO YOU, YOU MAY ASK THEM TO FAX IT TO US AT 298-2256.

Thank you.