Direct Access

Direct access can be offered for diagnostic procedures in selected patients.

In general, the indication for the procedure must be straightforward and the patient must be suitable from a general medical perspective. Suitable patients must have a good airway. The airway should be assessed using the Malampatti score. A suitable airway is indicated by the ability to visualise at least part of the soft palate when the patient opens their mouth widely with out vocalising or yawning.

Grades 1-3 are suitable. The patients overall suitability can be assessed using the ASA system (image on right). ASA class 1 and 2 patients are suitable for direct access.

Patients with Grade IV airways and/or ASA 3 or higher and/or On Warfarin/other anticoagulants or Insulin should be assessed by the Consultant Gastroenterologist in a clinic setting prior to the endoscopic procedure.

You can refer patients by e-mail: Gerard.clarke@gerardclarke.com or fax 0906400100 or use our referral form below.

Please remember insurance & contact details.

Endoscopy Referral

* Required

Referring Doctor*

Referring Doctor Email or fax*

Name of Patient*

Address*

Telephone*

DOB*
Patient Date of Birth

Insurance*
Helath Insurance Provider

Policy*
Insurance Number and Plan Name (e.g. Plan B)

Test/Service Required *

Previous OGD or Colonoscopy
OGDColon

Previous OGD or Colonoscopy Date

Indication for Procedure*

Duration of Symptoms*

Medical History *

Medications and Allergies *

Preferred Hospital
Portiuncula HospitalSt Francis Balinderry, MullingarHermitage ClinicGalway ClinicNo Preference/ First Available

Disclaimer*
The patient is aware that the onus is on the patient to confim cover with their insurer. If a service is provided and cover is subsequently denied by the insurer the patient will be liable for the full amount. Self payers must pay before procedure. Cash, Cheque, VISA and MC accepted.
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Direct Access

Endoscopy Referral

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