Get Ct Patient History Form - Windsor Radiology 2020-2025

Filling out the CT Patient History Form is an essential step in ensuring accurate imaging and personalized care. This guide will help you complete the form online with clear instructions for each section.

Follow the steps to complete the form successfully.

1. Press the ‘Get Form’ button to access the CT Patient History Form and open it in your designated editor.
2. Begin by entering your personal details, including your name, date of study, physician's name, date of birth, and age. Ensure all information is accurate to facilitate your healthcare provider's assessment.
3. Fill out the General Medical History section carefully. Describe the reasons for your exam, and note any history of cancer or surgeries in the relevant area.
4. For the Pregnancy section, answer the questions regarding pregnancy status and menstrual history accurately. If there is a chance you may be pregnant, inform the technologist immediately.
5. Proceed to the Asthma/Allergy History section. Indicate if you have asthma, your usage of inhalers, and any history of severe allergic reactions.
6. In the Contrast Allergy History section, state whether this is your first time receiving x-ray contrast and any reactions you might have had previously.
7. Complete the Steroid Premedication History by indicating if you have taken steroids for previous x-ray exams.
8. Continue with the Kidney Function History section, where you will answer questions related to diabetes, kidney disease, and any medications you are taking that may affect kidney function.
9. Lastly, sign the form in the Signature section, including your printed name and date, confirming that all information provided is accurate.
10. Once you have filled out all sections, save your changes, and utilize options to download, print, or share the completed form as needed.

Complete your CT Patient History Form online today for a smooth and efficient experience.