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PATIENT PREPARATION FOR DIAGNOSTIC TESTING
Please print this form, fill it out and take it with you to the doctor's off
Manassas Heart Center, LLC
8100 Ashton Ave., Suite 200
Manassas, VA 20109
703-335-8646
Patient Name: ____________________Date: __________ Time: _________
Resting Muga Scan:
  1. Wear comfortable clothing.
  2. You may eat or drink prior to study.
  3. You will be here approximately 90 minutes.
  4. Bring your insurance card/cards, written order from your physician and
    completed referral form if required by your insurance company.