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VascularVascularVein Services andand InterventionalInterventional ServicesServices

VeinVein ServicesServices ToTo schedule schedule a a consultation consultation or or for for more more information information about about vein services, services, please please call call 704.367.7877, 704.367.7877, faxfax this this order order form form or or visit visit CRveins.com. CRveins.com.

Reason for referral: Preferred Vein Center Location: ☐ 15419 Hodges Circle ☐ 4525 Cameron Valley Parkway ☐ Visible varicose or spider veins Suite 201 Suite 1000 ☐ Experiencing , aching, heaviness, tiredness in legs Huntersville, NC 28078 Charlotte, NC 28211 ☐ Leg cramps P 704.367.7877 P 704.367.7877 ☐ Restless leg syndrome F 704.943.3001 F 704.943.3008 ☐ Skin discoloration and or venous ulcerations ☐ Bleeding from varicosities To schedule a consultation or for more information about vein services, please LakeLake NormanNorman ☐ Unexplained leg swelling call 704.367.7877, fax this order form or visit CharlotteRadiology.com. ☐ Unexplained tingling, burning, itching in legs

Compression Stockings Prescription Information:

• Most insurance companies require a conservative period (wearing Compression Stockings) prior to any vein treatment. • When referring patients for a vein consult, please prescribe compression stockings at the time of referral. • Prescriptions should reflect that stockings need to cover the entire leg, and should be measured up to the groin (not mid thigh). • Please submit proof of prescription at time of referral. • Prescriptions should be coded to 187.2 Venous Insufficiency for submission to insurance. • Prescriptions can be filled wherever Compression Stockings are sold. Below are our recommended locations:

Compression Works Tega Cay Wellness Source 2001 East 5th St. 729 Crossroads Plaza 125 Commerce Park Road, #105 Charlotte, NC 28205 Fort Mill, SC 29708 Mooresville, NC 28117 704-376-5353 803-547-6100 704-799-2873

CMC-Rx Morrocroft Medical Plaza Lakeside Pharmacy South End Pharmacy 4525 Cameron Valley Pkwy, Suite 1200 9615 Sherill Estates Road, Suite B 1401 Albright Road Charlotte, NC 28211 Huntersville, NC 28078 Rock Hill, SC 29730 704-512-6040 P: 980-441-8600 F: 980-441-8625 803-366-3784 CR-IRServicesForm.pdf 1 2/15/21 12:24 PM

VascularReferring and Interventional Guide: Services When to Refer to Interventional vs. When to Refer for Vein Treatment

Vascular and Interventional Specialists at Charlotte Radiology are a subspecialized group of that are trained to diagnose and treat disease under image guidance with minimally invasive techniques.

Our Practice We offer comprehensive vascular care through interventional radiology. Many conditions that once required traditional can now be treated less invasively. Our interventional radiologists use image-guidance to diagnose and treat disease, minimizing trauma to the body and reducing infection rates and recovery time. The experts of Vascular and Interventional Specialists at Charlotte Radiology perform a list of minimally invasive procedures, offering patients a safe alternative to surgery.

Our Vein Treatment Practice To schedule a consultation or for more information about vascular and interventional VascularVascular and Interventional Interventional Specialists Radiology also treat Services varicoseservices, and spider please call veins ..IR at two outpatient or fax your vein order centers. to .. Our . interventional radiologists are subspecialized in vein and vascular diagnoses and treatments, which means they have the training and expertise necessary to treat your vein disease at its source. The minimally-invasive treatments we offer can provide significant and lasting relief to patients.

When to refer to Interventional Radiology Clinic: When to refer to Vein Treatment Center:

Patients with positive screening test (ABI <0.9) and Patients with symptoms of venous insufficiency: lower extremity symptoms • Lower extremity

Patients with

Patients with lower extremity rest pain • Superficial thrombophlebitis

Patients with non-healing, ischemic wounds, or risk • Venous stasis ulcers Atrium Health CMC Main of impaired wound healing post-op Atrium Health NorthEast PatientsAtrium Healthwith symptomatic Pineville acute or chronic DVT Atrium Health University Atrium Health Union Urgent / First Available