Get Mri Requisition Form - St. Michael's Hospital

This guide provides clear and supportive instructions on how to complete the MRI Requisition Form for St. Michael's Hospital. By following these steps, users can efficiently fill out the form online to ensure a smooth appointment process.

Follow the steps to fill out the MRI requisition form correctly.

1. Press the ‘Get Form’ button to access the requisition form. This will open the document in the editor for you to fill out.
2. Begin by providing the patient ID, ensuring all identifying details are clear and accurate. Enter the patient's name, date of birth (in the format D/M/Y), address, and medical record number.
3. Indicate the patient's weight in kilograms, and then select the gender by marking either 'Male' or 'Female'. If applicable, fill in the health card number and home telephone number.
4. Document the name of the attending physician, and provide both their mobile/work telephone number and fax number for correspondence.
5. Specify any copies of the form that should be sent to additional physicians by filling in their names and contact details.
6. In the clinical information section, clearly indicate any relevant medical history including previous MRI experiences and potential safety hazards associated with the MRI process.
7. Fill in specific questions about the patient's health regarding diabetes, kidney function, age, claustrophobia, and pregnancy or breastfeeding status as applicable.
8. Address the section regarding any metal implants or medical devices the patient may have. Be specific and thorough in your responses to avoid any safety issues during the MRI.
9. In the surgery history section, list all prior surgeries and implants, including dates and locations, to ensure compatibility with MRI equipment.
10. After completing the form, review all entries for accuracy. Ensure that the physician signs the form and dates it before submission.
11. Save your changes, and choose to download, print, or share the completed form as required, ensuring it is sent to the appropriate MRI department.

Complete the MRI requisition form online today to facilitate your appointment at St. Michael's Hospital.