H Pylori Breath Test Prescription

(This test can be done at laboratories such as LabCorp, Quest or bio-reference)

Patient Instructions:

1. This is a Breath Test to detect bacteria called H.Pylori in your Stomach. It involves swallowing Capsule and then breathing into a balloon. The Test will last approximately 15 Minutes.

2. You should not take any Antibiotics, Pepto Bismol, Nexium, Prilosec, Omeprazole, Prevacid, Aciphen or Protonix for 3 Weeks prior to the test.

3. Tums, Zantac, Pepcid and Mylanta do NOT have to be stopped.

4. No breakfast or coffee the morning of the test and do not take your Medications that morning.

5. No Smoking the morning of the test.

Diagnosis: H.Pylori Infection (ICD10: B96.81 / K29.60)

Feel free to call our office with any questions.

Sincerely,

Chintan Modi, MD

**IT IS THE PATIENT’S RESPONSIBILITY TO USE A LAB COVERED BY THEIR INSURANCE**.