Gastroenterology Referrals
All appointments and procedures for GI and endoscopy services require a referral. You can refer a patient online or by fax for:
- A clinic appointment
- A direct, open-access procedure
You can only directly refer a patient for a procedure without a clinic visit if the patient:
- Is a Virginia resident
- Doesn't have significant comorbidities
- Will not need more in-depth, ongoing care
Patients should not be referred for procedures and clinic appointments at the same time. All second-opinion referrals need to come directly from the patient’s current gastroenterologist.
Make a GI Clinic Referral
Follow these steps to fax or make an online gastroenterology referral.
Referrals with Epic
If you have access, you can make an "Ambulatory GI Referral."
Want to sign up for online access to patient records and more? Learn how to get connected through EpicCare.
Fax Referrals
Fax the GI clinic referral form (PDF) to 434.244.9445.
Questions? Call 434.243.3090
Make an Endoscopy Referral
Fax the Endoscopic Procedure Order Form (PDF) to 434.924.8144.
Questions? Call: 434.924.9999
Colonoscopy Prep
Alternative Bowel Prep Guidelines
There is a national shortage of bowel preparation GoLYTELY and its alternatives (Colyte, NuLYTELY, GaviLYTE, and Trilyte). The shortage should end in Spring 2021.
We have worked with UVA Pharmacy to create a decision algorithm and protocol to standardize the ordering of alternative bowel preparations.
By doing this, we hope to reserve the limited preparations for patients who can't use alternatives.
Bowel Preparation Comparison Table
Drug Brand Name | Volume | Patient Clinical Criteria | Estimated Out-of-Pocket Cost to Patient |
|---|---|---|---|
Miralax + Gatorade (not red or purple) + bisacodyl 10mg (5mg x 2 tabs) | 238g mixed with 64 oz Gatorade | First line, unless patient meets criteria for GoLYTELY listed below | ~$15 |
Suprep | 2.8L | Second line to Miralax prep due to cost and some evidence of less efficacy | $75-$110 |
-GoLYTELY, GaviLyte-G (236g) -Colyte, GaviLyte-C (240g) -NuLYTELY, GaviLyte-N, Trilyte (420g)
| 4L | RESERVE prep for patients with the following considerations:
| $15-$20 |
MoviPrep | 2L | Second line to GoLYTELY and equivalents, except in patients with a history of:
| $65 (generic) $135 (brand) |
Clenpiq | 320 mL + at least 72oz of additional clear liquid throughout prep | If patient unable to obtain Miralax or Suprep
| $160 |
Plenvu | ~ 2L | If patient unable to obtain Miralax or Suprep
| $125 |
Gastrointestinal & Digestive Health
- GERD Treatment
- Achalasia Treatment
- Colorectal Surgery
- Eosinophilic Esophagitis Treatment
- Fecal Transplant for C Diff
- Gallstone Treatments
- Gastrointestinal Cancers
- Liver Disease Treatment
- Endoscopic Retrograde Cholangiopancreatography
- Endoscopic Ultrasound
- Endoscopy
- Small Bowel Resection
- Upper GI Endoscopy
- Support Resources
- Digestive Health for Children
- Inflammatory Bowel Disease
- Motility Disorders & Diagnostics
- Referrals
- Ostomy Treatments & Care
- Gastroparesis Treatment
PER Colonoscopy
09/04/2025
03135 - Colonoscopy Consent Patient Education
Document Description: Consent Patient Education. Not intended for the EMR.
09/04/2025
03135 Spanish - Colonoscopy Consent Patient Education
Document Description: Consent Patient Education. Not intended for the EMR.
09/04/2025
03134 - Preparing for Your Colonoscopy with UVA Digestive Health Suprep Extended Bowel Preparation
09/04/2025
03126 Spanish - Preparation Instructions, Sutab
Document Description: Sutab colonoscopy bowel prep instructions in Spanish with checklist and diet instructions
09/04/2025
03126 - Preparation Instructions, Sutab
Document Description: Sutab colonoscopy bowel prep instructions with checklist and diet instructions
09/04/2025
03123 - Clenpiq Bowel Prep Instructions
Document Description: Clenpiq bowel preparation instructions with checklist and diet instructions.
09/04/2025
03123 Spanish - Clenpiq Bowel Prep Instructions
Document Description: Clenpiq bowel preparation instructions in Spanish with checklist and diet instructions.
09/04/2025
03121 - Plenvu Bowel Prep Instructions
Document Description: Plenvu bowel preparation instructions with check list and diet instructions.
09/04/2025
03121 Spanish - Plenvu Bowel Prep Instructions
Document Description: Plenvu bowel preparation instructions in Spanish with check list and diet instructions.
09/04/2025
03120 Nepali - Colorectal Cancer Screening: An Informational Video for Nepali-Speaking Patients
Document Description: This 8-minute video describes the two most common procedures for colorectal cancer screening: fecal occult blood testing and colonoscopy. It is presented entirely in Nepali and includes: Reasons for screening and eligibility Demonstration of how to do home fecal occult blood testing Demonstration of the steps of a colonoscopy: preparation, the actual procedure, and recovery period
09/04/2025
03116 - MiraLAX Colonoscopy Bowel Prep Instructions
Document Description: MiraLAX colonoscopy bowel prep instructions in Spanish with checklist and diet instructions
09/04/2025
03116 Spanish - MiraLAX Colonoscopy Bowel Prep Instructions
Document Description: MiraLAX colonoscopy bowel prep instructions in Spanish with checklist and diet instructions
09/04/2025
03047 Spanish - Suprep Bowel Prep Instructions
Document Description: Standard bowel preparation instructions with check list and diet instructions.
09/04/2025
03085 - Golytely Extended Bowel Preparation Instructions
Document Description: Recommended for those with past poor prep and/or chronic constipation.
09/04/2025
03085 Spanish - Golytely Extended Bowel Preparation Instructions
Document Description: Recommended for those with past poor prep and/or chronic constipation. (Spanish)
09/04/2025
03046 Spanish - Golytely Standard Bowel Preparation Instructions
Document Description: Standard bowel preparation instructions with check list and diet instructions.