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MRISCREENING QUESTIONNAIRE Name: Age: Weight: Date: / / Patient safety is our primary concern. Some of the following items can interfere with Magnetic Resonance Imaging and some can be hazardous to.

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How to fill out the OUTPATIENT MRI QUESTIONNAIRE online

Completing the OUTPATIENT MRI QUESTIONNAIRE is essential for ensuring your safety during an MRI scan. This guide provides step-by-step instructions to help you fill out the form accurately and efficiently online.

Follow the steps to complete the questionnaire seamlessly.

  1. Click ‘Get Form’ button to access the form and open it in your preferred online editor.
  2. Begin by entering your personal information, including your name, age, and weight in the designated fields at the top of the questionnaire.
  3. Carefully read through each question regarding your medical history and health conditions. Respond to each item with a 'Yes' or 'No' as applicable. It’s crucial to provide accurate information for your safety.
  4. Continue progressing through the questionnaire, addressing any past surgeries, medical implants, or conditions that may affect your MRI. Each question is designed to gather important safety information.
  5. If any symptoms or medical history need detailing, ensure to describe them clearly in the spaces provided. Follow the prompts for listing symptoms and any relevant medical procedures.
  6. When you complete all sections of the questionnaire, review your answers to ensure accuracy. Any discrepancies may delay your MRI appointment.
  7. Once you've verified your information, save the changes to your questionnaire. Depending on the options available, you may also download, print, or share the completed form as needed.

Take a moment to complete the OUTPATIENT MRI QUESTIONNAIRE online for a smooth MRI experience.

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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 ...

MRI Technologists You should become familiar with the MRI safety policies and procedures at your site, as well as the contact information for the MRI safety officer to whom you can go to if you have questions.

This zone is restricted from general public access by a reliable restricting method that can differentiate between MR and non-MR personnel. Zone 4: Magnet Room. No individual is allowed in the scan room without being supervised by trained MRI personnel. The scan room door is always locked when unattended.

Always, place a cloth material between the wires and skin to help prevent burns.. Who must be screened before entering the scan room? EVERYONE!!! Every person that enters the MRI room must be screened for possible contraindications that could affect their health and safety.

“What information will the MRI scan provide? How might this change my treatment options?” “Is there any reason why I shouldn't have an MRI scan?” (If you have any implanted devices (such as a pacemaker, stents, an pump, or an artificial joint), be sure your doctor knows about them.)

Level 1 MR personnel: Those who have passed minimal safety educational efforts to ensure their own safety as they work within Zone III. Level 2 MR personnel: Those who have been more extensively trained and educated in the broader aspects of MR safety issues.

Always, place a cloth material between the wires and skin to help prevent burns.. Who must be screened before entering the scan room? EVERYONE!!! Every person that enters the MRI room must be screened for possible contraindications that could affect their health and safety.

Remove all metal items such as hair clips, jewelry, watches, hearing aids and dentures. Credit cards will be erased if brought into the MRI. You will be asked to change into a gown for your exam. Tell your doctor and the MRI technologist if you suffer from claustrophobia (fear of being closed in).

All MRI staff must take responsibility for providing an MRI-safe environment for staff and patient alike. 5. The first protocol: No one enters the magnet room (Zone IV) without the approval of the MRI technologist – without exception.

MRI safety program essentials should include: Restricting site access (see the MRI Functional Diagram). Screening of devices and rating of hazardous materials/equipment. Screening staff and patients to identify any potential risks such as implants (including passive implants) or metallic objects.

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