Get (mr) Procedure Screening Form For Patients - Bric - Bric Uchicago
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How to fill out the (MR) PROCEDURE SCREENING FORM FOR PATIENTS - BRIC - Bric Uchicago online
Filling out the (MR) PROCEDURE SCREENING FORM FOR PATIENTS is an important step in ensuring that you receive safe and appropriate care. This guide provides a clear and supportive approach to completing the form online, helping you understand each section and its requirements.
Follow the steps to complete the form effectively.
- Click ‘Get Form’ button to obtain the form and open it in your preferred editing tool.
- Begin by entering the date of your appointment in the format of month/day/year.
- Fill in your patient number, followed by your full name, including first name, last name, and middle initial, if applicable.
- Input your date of birth in the month/day/year format, then provide your age, height, and weight.
- Select your gender by marking the appropriate box.
- Indicate the specific body part that is to be examined.
- Provide your complete address, including home and work telephone numbers, city, state, and zip code.
- State the reason for the MRI and any symptoms you are experiencing in detail.
- Include the name and contact number of your referring physician.
- Answer the questions regarding prior surgeries, diagnostic imaging studies, and any related problems by selecting 'Yes' or 'No,' and provide details if applicable.
- Complete the sections concerning medications, allergies, and medical history with accurate information.
- For female patients, fill out the questions related to your menstrual history and any potential pregnancies.
- Review the list of implants and devices and indicate whether any apply to you.
- Draw on the provided figures to mark any implants or metal within your body.
- Acknowledge the instructions regarding safety before entering the MR environment.
- At the end of the form, attest to the accuracy of the information provided by signing and dating the form.
- After completing the form, save your changes, and choose to download, print, or share the document with the necessary parties.
Start filling out your (MR) PROCEDURE SCREENING FORM FOR PATIENTS online today to ensure a smooth and safe MRI experience.
Related links form
To schedule an MRI at Uchicago, visit our website or call our scheduling department directly. You'll need to provide your physician's order along with basic personal information. Our team will help you choose a convenient date and time for your appointment. Don't forget to complete the MR PROCEDURE SCREENING FORM FOR PATIENTS - BRIC - Bric Uchicago prior to your visit.
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