Office address:

 

19415 Deerfield Avenue

Suite 213

Lansdowne, Virginia 20176

 

Phone: 703-724-9474


Fax: 571-346-1921

 

Patient Forms

PLEASE MAKE SURE YOU SCROLL DOWN AND READ THIS ENTIRE SECTION.

Dr. Chiantella's practice is managed by Loudoun Medical Group. You may see this on some of the registration documents.

 

NEW PATIENTS: Please print and complete the registration forms below. These documents can not be completed online. Please bring your completed forms to your appointment, and please arrive at least 15 minutes ahead of your appointment time. DO NOT EMAIL THESE FORMS as this is private information and your outgoing emails are not encrypted. If you prefer to complete the forms in the office, before your appointment, please arrive 45 minutes early, and we will provide the forms for you at that time.

 

RETURNING PATIENTS: Please arrive 15 minutes before your appointment time. There are no online documents for you to complete. (Yay!)

This is what you need to bring to your appointment:

--Your current insurance card and photo ID.

--A list of all your medications, including name, strength, and dose of each medicine and supplement

--A referral if your insurance requires it. It is your responsibility to know if your insurance plan requires a referral

 

Wear a two piece outfit so you can easily change into an exam cape that ends at your waist.

 

 

Breast images are now accessible to physicians through secure portals at all radiology centers. The physician portals allow images to be accessed and viewed via computer. Because of this, we no longer require that you pick up any films or CDs of imaging for your office visit, unless the imaging was done out of the area. We also access the radiology reports in this manner. Below is a list of facilities for which we have computer portal access. If your facility is not on the list, please call our office:

Reston Radiology: Loudoun Imaging in Ashburn, Fair Oaks Imaging Center, Womens Imaging of Reston (on the Reston Hospital Campus)

Fairfax Radiology - all locations are accessible, including Inova Loudoun Hospital, the Cornwall campus, and what used to be called RIA in Lansdowne and CountrySide/Sterling

Washington Radiology - all  locations are accessible

Progressive Radiology in Winchester

 

I DO NOT have computer access to imaging from:  Winchester Medical Center, Novant facilities, Prince William Hospital, Fauquier Hospital, Virginia Hospital Center, George Washington Hospital system, Medstar Georgetown, Johns Hopkins/Sibley. Imaging from these sites MUST be provided on CD.

If your imaging was done out of the area, you will need to arrange for a CD to be sent to the office and it must arrive prior to your appointment. Otherwise, CDs may be brought at the time of your appointment.

 

Please be aware that I share office space with a primary care practice. The office is practicing social distancing in the reception area. You may not enter the office without a mask. Please do not bring your children to your visit with me. We will call you with a series of screening questions prior to your visit, and if there are any positive answers we may ask you to rechedule after 2 weeks of self-quarantine. The primary care portion of the office does the same, and is not permitting any patients to enter the office who may have symptoms related to COVID. It may sound silly at first, but please bring your own pen if you need to fill out paperwork in the office, and there are hallway sinks available inside the office if you wish to wash your hands on entering and/or before leaving. My patients do not share exam rooms or any equipment used by the primary care practice.

 

AN IMPORTANT WORD ABOUT DIGITAL AND 3D BREAST IMAGING:

When viewing breast images via computer, please be aware that the image quality is NOT THE SAME as what the interpreting radiologist sees, as the radiology viewing system is very sophisticated and of significantly higher resolution than monitors outside of the imaging center. In that regard, it is sometimes difficult for me to render a completely independent review of your images. If that is true in your case, I will discuss it with you after I review your images in the office.

 

The 3D portion of a 3D mammogram is read dynamically by scrolling through a series of images rapidly, much like a video, and your eye is drawn in and out of the tissue uncovering the anatomy better than a single flat (2D) image. Until recently, the 3D portion of a mammogram study could be scrolled through ONLY ON THE SYSTEM WHERE IT WAS RECORDED,  ie, only in the imaging center where it was taken, NOT via computer outside of the imaging system. HOWEVER Loudoun Imaging Center in Ashburn has software that allows me to scroll through the images remotely, thankfully! The only other site for which I can do this is Progressive Radiology in Winchester. Therefore, for local imaging needs you may wish to consider having your imaging done at Loudoun Imaging in Ashburn, so I can see what the radiologist sees, and not just the 2D portion of your study.

 

 

 

 

PRINT FOR REFERENCE
appt_checklist2020a.pdf
Adobe Acrobat document [116.0 KB]
PLEASE PRINT AND COMPLETE
Health History Form_2020a.pdf
Adobe Acrobat document [330.1 KB]
PLEASE PRINT AND COMPLETE IF YOU ARE NEW TO LMG
Patient Information_2020.pdf
Adobe Acrobat document [319.1 KB]
PLEASE PRINT AND COMPLETE
Authorization to Disclose Health Informa[...]
Adobe Acrobat document [35.9 KB]
PLEASE PRINT AND SIGN AFTER REVIEWING PRIVACY POLICY
Privacy Signature Page_2020.pdf
Adobe Acrobat document [337.2 KB]
PRIVACY POLICY, PLEASE READ
Privacy Policy_2020.pdf
Adobe Acrobat document [337.2 KB]

We accept most types of health insurance. Please contact us for further details, or if you have any questions at all regarding your appointment.

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© Virginia Chiantella MD