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CT Contrast History Form Exam date Patient name DOB ? Female ? Male Weight Height 1. Is there any chance of pregnancy? ? Y ?N ?Y ?N 2. Are you currently breast feeding? Date of last menstrual period.

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In most cases contrast dyes used in tests, such as CT (computerized tomography) and angiograms, have no reported problems. About 2 percent of people receiving dyes can develop CIN. However, the risk for CIN can increase for people with diabetes, a history of heart and blood diseases, and chronic kidney disease (CKD).

For some CT scans, you will be asked to drink a special liquid called an oral contrast between 60-90 minutes before your test. This liquid includes barium and will help your doctor get a better picture of your abdomen. You may instead be hooked up to an IV with a contrast dye.

Generally, there is no fasting requirement prior to a CT scan, unless a contrast dye is to be used. Your doctor will give you special instructions ahead of time if contrast is to be used and if you will need to withhold food and drink. Notify the technologist if you are pregnant or suspect you may be pregnant.

Instructions for taking Oral Contrast (Barium Sulfate) Begin drinking the contrast one and a half hours before your scheduled exam time. Drink one-third of a bottle every fifteen minutes.

The morning of your appointment, please shake well and drink one (1) bottle of barium at approximately 7 am. Take medications with water as usual, but do not eat or drink anything except water 4 hours prior to your appointment.

CONTRAST MEDIA: CT scans are most frequently done with and without a contrast media. The contrast media improves the radiologist's ability to view the images of the inside of the body. Some patients should not have an iodine-based contrast media.

With normal kidney function, most of the gadolinium is removed from your body in the urine within 24 hours. If you have acute renal failure or severe chronic kidney disease and receive a gadolinium-based contrast agent, there may be a very small risk of developing a rare condition.

Iodine-based and Gadolinium-based. Iodine-based contrast materials injected into a vein (intravenously) are used to enhance x-ray and CT images. Gadolinium injected into a vein (intravenously) is used to enhance MR images.

CONTRAST MEDIA: CT scans are most frequently done with and without a contrast media. The contrast media improves the radiologist's ability to view the images of the inside of the body. Some patients should not have an iodine-based contrast media.

How long will the scan take? The time required will depend upon the type of scan. If oral contrast is required, about 45 to 60 minutes is needed for the contrast to move through your digestive tract. Actual scan times vary from a few seconds to several minutes.

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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