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  • Patient Consent And Screening Form - Bio-magnetic Mri/mra ...

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LOCATION: MRI/MRA Imaging Centers PATIENT CONSENT AND SCREENING FORM NAME: HT: WT: AGE: MR# NAME: HT: WT: AGE: MR# There are no known risks associated with being within this particular magnetic field.

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This form is meant to provide you with information about the procedures and risks associated with MRI scanning and to obtain your consent to participate.

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).

On the day of your MRI scan, you should be able to eat, drink and take any medication as usual, unless you're advised otherwise. In some cases, you may be asked not to eat or drink anything for up to 4 hours before the scan, and sometimes you may be asked to drink a fairly large amount of water beforehand.

A) Absolute contraindications: The cardiac implantable electronic device (CIED) such as pacemakers, implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT) devices: Patients with CIED are at risk for inappropriate device therapy, device heating/movement, and arrhythmia during MRI.

Magnetic resonance imaging (MRI) of human subjects is widely performed for clinical and research purposes. Clinical MRI requires a physician order, while research MRI typically requires an approved protocol from a local Institutional Review Board, as well as informed consent.

Instruct the patient to remove all metallic objects, including jewelry, hairpins, and watches. Ask the patient if he has any implanted metal devices or prostheses, such as vascular clips, shrapnel, pacemakers, joint implants, filters, and intrauterine devices. If so, the test may not be able to be performed.

MRI, or magnetic resonance imaging, uses radio waves, a magnetic field, and a computer to create images of the inside of the body. MRA, or magnetic resonance angiography — sometimes called a magnetic resonance angiogram — is a magnetic resonance procedure that zeroes in on the blood vessels.

On the day of your MRI scan, you should be able to eat, drink and take any medication as usual, unless you're advised otherwise. In some cases, you may be asked not to eat or drink anything for up to 4 hours before the scan, and sometimes you may be asked to drink a fairly large amount of water beforehand.

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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