Get Magnetic Resonance (mr) Procedure Screening Form For Patients

Filling out the magnetic resonance (MR) procedure screening form for patients is an essential step before undergoing an MRI. This guide will provide you with clear instructions to ensure you complete the form accurately and efficiently online.

Follow the steps to fill out the MR procedure screening form seamlessly.

1. Click the ‘Get Form’ button to access the form and open it in the designated online platform.
2. Begin by entering the date of completion in the designated field. This is crucial for record-keeping.
3. Input your patient number, followed by your full name, including last name, first name, and middle initial.
4. Provide your date of birth in the specified format, ensuring accuracy for identification purposes.
5. Indicate your gender by selecting the appropriate option, and fill in your age, height, and weight.
6. Detail the body part that will be examined during the MRI and describe the reason for the MRI and any symptoms you experience.
7. Respond to the section regarding any prior surgeries on the body part undergoing the MRI, including dates and types of surgeries, if applicable.
8. Complete the section about previous diagnostic imaging studies by listing any relevant exams and their details.
9. Indicate if there have been any issues related to past MRI examinations and provide descriptions if applicable.
10. List current medications, including dosage and frequency, ensuring to mention any allergies.
11. Answer health-related questions concerning asthma, blood disorders, renal issues, and other health conditions.
12. For individuals who identify as female, complete the additional questions regarding menstrual cycles, pregnancy, and birth control.
13. Review the warnings regarding potential hazards and ensure all metallic objects are accounted for before the procedure.
14. Finally, attest to the accuracy of the information provided and sign the form. Indicate who completed the form and the relation to the patient.
15. Once completed, save changes, download, or print the form, ensuring you retain a copy for your records.

Start filling out your MR procedure screening form online today to ensure a smooth and safe MRI experience.