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MRI Patient History and Screening Form Patient Name Weight Date D. O. B Age Sex M F Referring Physician Allergies Reason you are here today Explain your medical problem in detail such as What and where is the problem and how long have you had it Yes No Is your problem injury related. Injury Date How Injured MVA Work Other Yes No Have you had a previous exam related to this problem If Yes explain If yes Do you have someone to drive you home Yes No Do you have or have you ever had any of the following Yes No Shunts/Stents/Intravascular Coil Yes No Eye Surgery/Implants Yes No Orthopedic pins screws rods Harrington Rod etc. Yes No Neurostimulator/Biostimulator Implanted cardiac defibrillator Yes No Radiation Therapy/Chemo Therapy Yes No Vascular Access Port Yes No Metal Mesh Implants/Wire sutures/wire staples/internal electrode Yes No Implanted drug infusion pump/ pump Yes No Tattoo s/Permanent make-up/Body Piercing Yes No Dentures partials or dental implants Yes No Gunshot Wounds shrapnel....

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Getting your MRI scan results The Radiologist will send a report to the doctor who arranged the scan. They'll discuss the results with you. It usually takes 1 to 2 weeks for the results of an MRI scan to come through, unless they're needed urgently.

You can find the MRI Pre-Screening Checklist in Epic by going to Order History and finding the order for the MRI....There are four zones in the MRI department: Zone 1: General public. Zone 2: Pre-screened patients/visitors. Zone 3: MRI control room/restricted access. Zone 4: MRI scan room/restricted access.

MRI scans are fast, accurate, painless, and non-invasive ways to screen for signs of possible cancer and other health issues. A whole body MRI scan is safer than other scanning methods, as it doesn't use harmful ionizing radiation.

The MRI questionnaire is designed to identify all potential implants and/or foreign bodies that the patient has. These are then assessed to decide whether there is a risk involved in scanning the patient. In cases where implants are common or well-known, radiographers will decide whether imaging can proceed.

Screening means taking pictures of various parts of your body to detect cancer or other serious problems early on before symptoms appear. Diagnostic imaging, which includes x-rays and MRI scans, is used to determine what caused a specific problem with a person's health.

Individuals undergoing an MRI procedure must remove all readily removable metallic personal belongings and devices on or in them (e.g., watches, jewelry, body piercing if removable, contraceptive diaphragms), metallic drug delivery patches, and clothing items which may contain, metallic fasteners, hooks, zippers, loose ...

The screening form for individuals requests general information (name, age, address, etc.) and poses important questions to determine if there are possible problems or issues that should be discussed with the individual prior to permitting entry to the MR environment.

Is there any possibility that you are, or may be, pregnant? Are you currently breastfeeding? Do you have an implanted IUD? Have you had any problems during prior MRI scans?

Magnetic resonance imaging (MRI) of the abdomen. The patient lies on a table that slides into the MRI machine, which takes pictures of the inside of the body.

Patients are normally screened for contraindications to MRI using a hospital-approved screening form prior to entering the scanner suite. This form is completed by the patient or by his or her healthcare provider, and reviewed by the scanning technologist prior to the patient's MRI examination.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232