Viaradiology.com

Patient Information
Written Diagnosis/Symptoms/Reason for Exam(s)
Please list signs and symptoms, along with any clinical information that is pertinant to this study. Include ICD-9 Code(s):
Exam Requested
ULTRASOUND
INTERVENTIONAL PROCEDURE
� Contrast �No Contrast
� Contrast �No Contrast
Spine Pain Management
� Radiologist to Decide
� Radiologist to Decide
Head & Neck
Head & Neck
�Joint Pain Management
Chest (choose only one)
Body/Trunk
Interventional Miscellaneous
Abdomen/Pelvis
Consultation
Vascular
Extremity
Extremity (specify) R / L
Joint MR Arthrogram
Miscellaneous
Other (specify)
Reporting
Preparing for your exam or procedure
The exam requires no preparation. There are no restrictions on food or drink.
Our staff will screen for reasons MRI might not be safe. In particular, no pacemakers or implantable cardio-defibrillators are allowed.
For your exam, please wear loose and comfortable clothing. Once you arrive, you may be asked to change into the appropriate clothing for your
exam, since metal objects may interfere with the quality of your study. If your exam requires a contrast agent or “dye” to enhance the appearance
of certain tissues or blood vessels in the images, a small needle will be placed in a vein in your arm, and a contrast agent will be injected.
In some cases your doctor may have ordered a “Joint MR Arthrogram.” In these cases a separate procedure will be performed to inject contrast
into that joint.
Please let us know in advance whether you have kidney failure, or whether you are or might be pregnant.
Certain CT exams require the use of contrast. If you are having an exam that requires a contrast agent or “dye,” you may be asked to avoid food or fluids for 4-8 hours before the test. We will let you know if you need to follow these additional preparations: For CT abdomen and/or pelvis: No solid foods after midnight prior to your exam. Medications may be taken and clear liquids are allowed. For CT chest, head and neck: No solid food for four hours prior to your exam. Medications may be taken and clear liquids are allowed. Drink plenty of fluids prior to your exam, unless you are told to do otherwise as part of your exam preparation.
For your exam, please wear loose and comfortable clothing. Once you arrive, you may be asked to change into the appropriate clothing for your exam, since metal objects may interfere with the quality of your study. You may be asked to drink a liquid contrast agent upon arrival for exams of the abdomen and pelvis. If your exam requires an intravenous contrast agent, a small needle will be placed in a vein in your arm for the injection. Please let us know in advance if you have any allergies to iodine contrast, whether you are or might be pregnant, or if you are taking medication containing metformin: Glucophage, Glucovance, Avandamet or Metaglip.
For your exam, please wear loose and comfortable clothing – and bring an extra layer to stay warm and comfortable while you are waiting. Prior to your appointment, please let us know whether you might be pregnant, are currently breastfeeding, or are diabetic. Refrain from strenuous exercise 24 hours before your exam. You must have a driver.
Do not eat or drink anything except water for 6 hours before your exam.
Please do not chew gum.
Drink plenty of water the day before your exam; try to drink at least 48 ounces.
Take your normal medications with water, unless instructed not to do so by your physician.
Prior to your appointment, we will call you to review health and insurance information, to provide specific instructions about diet, and to ULTRASOUND
Preparation for your ultrasound study will depend upon the type of exam you are having:� Abdomen, Liver, Gallbladder, and Pancreas: DO NOT eat or drink six to eight hours prior to your exam, clear liquids like water are OK. Medications may be taken with water.
� OB and Pelvic: Arrive with a full bladder. Finish drinking two glasses of water one hour prior to your exam. Do not empty your bladder. � Kidneys: Drink two glasses of water 1 hour prior to your exam. Do not empty your bladder.
� Aorta and Abdominal Studies: Nothing by mouth six hours prior to exam.
� No preparation is necessary for ultrasound of the thyroid, scrotum, hernia, blood vessels, or extremeties.
� Preparation may vary for ultrasound-guided biopsy/aspiration procedures, please call to verify. Our Location
We are located at 11011 Meridian Avenue N., on the NW corner of Meridian Avenue N.
Northwest
and Northgate Way. Please see detailed driving directions below or visit us at
Hospital
www.viaradiology.com. Plenty of free, on-site parking is available at our convenient location.
and Medical
Center
Via Radiology is located on the first floor of the Meridian Pavilion in Suite 101.
115th St.
Exit at Northgate Way/1st Ave. NE, Exit 173. Take the Northgate Way Westbound ramp and Meridian
Roosevelt
turn right onto N. Northgate Way. Continue through the first light, which is the intersection of Northgate Way and Meridian Avenue N. Immediately after the light, turn right into the parking garage for Meridian N. Northgate Way
Northgate
Take the Northgate Way/1st Ave. NE, Exit 173. Turn left onto 1st Ave. NE. and then left onto 105th St.
Northwest
N. Northgate Way. Continue straight through two lights until you reach the intersection of Northgate Way Hospital
Outpatient
and Meridian Avenue N. Immediately after the light, turn right into the parking garage for Meridian Pavilion.
Medical
Center
From Highway 99/Aurora Ave N.:Turn east on Northgate Way (105th) and drive 0.6 miles. Immediately before the intersection of Meridian Avenue N. and Northgate Way, turn left into the parking garage for Meridian Pavilion.

Source: http://www.viaradiology.com/files/ReferralPad.pdf