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  • (SP) SERVICES (AR) (FA) Consultation Infusion Therapeutics … · 2019-09-11 · Nader H. Balba, MD Felice L. Banson, MD Michael A ... Peter L. Scudera, MD Rupa N. Shah, MD - (SP,
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Mahmood Abedi, MD - (FA) Tonya Adams, MD Nader H. Balba, MD Felice L. Banson, MD Michael A. Garone, MD Ivan P. Harnden, MD - (SP) Ahmed Hegab, MD - (AR) Behzad Kalaghchi, MD - (FA) Asma Khapra, MD Byungki Kim, MD - (KO) Iris Lee, MD - (KO) Kenneth R. Mirkin, MD Nitin Sardana, MD - (PA, HI) Peter L. Scudera, MD Rupa N. Shah, MD - (SP, GU) Jeremias C. Tan, MD Nicholas M. Szary, MD Bezawit D. Tekola, MD - (FR, AM) Stephanie Byers, PA-C Dana Fayyad, PA-C Heather Greenberg, PA-C Emarie Hill, PA-C - (KO, SP) Hanna L. Kim, PA-C Joanna May, PA-C Lindsay Tom, PA-C 703.698.8960 | MyGANV.com Physicians SERVICES Physician Assistants Patient Name: ________________________________________________ Patient DOB: ___________________________ Consultation Direct Access Screening Colonoscopy*: colon cancer screening for asymptomatic patients, no preliminary office visit required Referring Physician: _____________________________________________________________________________________ NOTES: __________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ CHIEF COMPLAINT______________________________________________________ (check all that apply) Abdominal pain Abnormal imaging Abnormal LFTs Barrett's Esophagus Cancer / Type:_______________________________ Celiac Disease Crohn's Disease Constipation Diarrhea Dyspepsia/GERD Fecal incontinence/InterStim consult Gallbladder or biliary tract disease Gl bleeding Heartburn Hemorrhoids Hepatitis B or C Inflammatory bowel disease Iron deficiency Irritable bowel syndrome Nausea or vomiting Obesity Pelvic Floor Dysfunction Infusion Therapeutics (Dx: Anemia, Arthritis, Crohn's, Colitis, IBD, IBS) Endo-bariatric Weight Loss Consultation (Complimentary) (KO) Korean | (FA) Farsi | (SP) Spanish | (AR) Arabic (FR) French | (GU) Gujarti | (AM) Amharic (PA) Punjabi | (HI) Hindi

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Page 1: (SP) SERVICES (AR) (FA) Consultation Infusion Therapeutics … · 2019-09-11 · Nader H. Balba, MD Felice L. Banson, MD Michael A ... Peter L. Scudera, MD Rupa N. Shah, MD - (SP,

Mahmood Abedi, MD - (FA)

Tonya Adams, MDNader H. Balba, MDFelice L. Banson, MDMichael A. Garone, MDIvan P. Harnden, MD - (SP)

Ahmed Hegab, MD - (AR)

Behzad Kalaghchi, MD - (FA)

Asma Khapra, MDByungki Kim, MD - (KO)

Iris Lee, MD - (KO)

Kenneth R. Mirkin, MDNitin Sardana, MD - (PA, HI) Peter L. Scudera, MDRupa N. Shah, MD - (SP, GU)

Jeremias C. Tan, MDNicholas M. Szary, MD

Bezawit D. Tekola, MD - (FR, AM)

Stephanie Byers, PA-CDana Fayyad, PA-CHeather Greenberg, PA-CEmarie Hill, PA-C - (KO, SP)

Hanna L. Kim, PA-CJoanna May, PA-C Lindsay Tom, PA-C

703.698.8960 | MyGANV.com

Physicians

SERVICES

Physician Assistants

Patient Name: ________________________________________________ Patient DOB: ___________________________

ConsultationDirect Access Screening Colonoscopy*:colon cancer screening for asymptomatic patients, no preliminary office visit required

Referring Physician: _____________________________________________________________________________________

NOTES: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

CHIEF COMPLAINT______________________________________________________ (check all that apply)

Abdominal painAbnormal imagingAbnormal LFTsBarrett's EsophagusCancer / Type:_______________________________Celiac DiseaseCrohn's DiseaseConstipationDiarrheaDyspepsia/GERDFecal incontinence/InterStim consult

Gallbladder or biliary tract diseaseGl bleedingHeartburnHemorrhoidsHepatitis B or CInflammatory bowel diseaseIron deficiencyIrritable bowel syndromeNausea or vomitingObesityPelvic Floor Dysfunction

Infusion Therapeutics(Dx: Anemia, Arthritis, Crohn's, Colitis, IBD, IBS)

Endo-bariatric Weight Loss Consultation(Complimentary)

(KO) Korean | (FA) Farsi | (SP) Spanish | (AR) Arabic(FR) French | (GU) Gujarti | (AM) Amharic

(PA) Punjabi | (HI) Hindi

Page 2: (SP) SERVICES (AR) (FA) Consultation Infusion Therapeutics … · 2019-09-11 · Nader H. Balba, MD Felice L. Banson, MD Michael A ... Peter L. Scudera, MD Rupa N. Shah, MD - (SP,

Our team specializes in the early diagnosis, evaluation and treatment of digestive diseases and conditions.

Areas of expertise include:

> Advanced Minimally Invasive Endoscopy > GERD/ Barrett's Esophagus > Inflammatory Bowel Disease (IBD) > Infusion Therapeutics> Liver Disease > Fecal Incontinence > Women's GI Issues > Hemorrhoid Resolution > Pancreatic & Biliary Disease> Medical Weight Loss

Visit our website to Learn more: MyGANV.com

Locations:

FairfaxComprehensive Care Center 3028 Javier Road Fairfax, VA 22031 Infusion Suite- 5th FloorEndoscopy Center- 4th FloorClinic- 3rd FloorResearch-2nd Floor

Fair Oaks3700 Joseph Siewick Dr., Ste 308Fairfax, VA 22033

Herndon100 Elden St., Ste 12Herndon, VA 20170

ChantillyClinic & Endoscopy Center3914 Centreville Rd., Ste 350Chantilly, VA 20151

O�ce Hours:8:ooam to 4:3opmMonday through Friday

To schedule an appointment at any of our o�ces, please call 703-698-8960.

We accept most major health insurance and Medicare. Please check with your insurance

company to verify coverage. For plans requiring a referral, patients are responsi-

ble for obtaining and bringing referrals with them to their appointments.

Care you can trust.


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