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Instructions & Forms

Here are instructions and forms for our patients to use for procedures and information at Clearwater Gastroenterology and Gem State Endoscopy.

Low Residue Diet

Follow this diet for 5 days in preparation for your colonoscopy. The list below details what foods are allowed and which ones to avoid.

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EGD Instructions

Follow these Instructions for your EGD (Esophagoduodenoscopy) procedure. Please avoid the use of alcohol 24 hours before your procedure.

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NuLYTELY Colonoscopy Prep

NuLYTELY is used to clean out the intestines before colonoscopy. Follow these instructions correctly to help your procedure go smoothly.

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SUFLAVE Colonoscopy Prep

SUTAB tablets are an oral osmotic laxative for cleansing of the colon in preparation for colonoscopy. Follow these colon prep instructions to help your colonoscopy procedure go smoothly.

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SUTAB Colonoscopy Prep

SUTAB tablets are an oral osmotic laxative for cleansing of the colon in preparation for colonoscopy. Follow these colon prep instructions to help your colonoscopy procedure go smoothly.

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Clear Liquid Diet

A clear liquid diet helps maintain adequate hydration, provides important electrolytes such as sodium and potassium, and provides some energy at a time when a full diet isn’t possible or recommended.The following foods ARE ALLOWED in a clear liquid diet: Water (plain,...

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Right to Receive a Good Faith Estimate of Charges

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

Statement of Non-Discrimination

We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex. We provide free aids and communications services to people with disabilities or language barriers upon request.

Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.