Get Iv Contrast Screening Form

Filling out the IV Contrast Screening Form online is a crucial step in ensuring patient safety during imaging procedures. This guide provides clear and detailed instructions for users to navigate each section of the form effectively.

Follow the steps to complete the IV Contrast Screening Form online

1. Click ‘Get Form’ button to obtain the form and open it in your chosen editor.
2. Begin by entering the patient's label at the designated area at the top of the form.
3. In Section A, provide information completed by the nurse, provider, or technologist. Fill in allergies and the ordering physician's name.
4. Input the patient's height in centimeters and weight in kilograms, then enter the date and time of filling out the form.
5. Respond to the questions regarding any adverse reactions to IV contrast media, renal impairment, and medications such as . Ensure you circle 'YES' or 'NO' as applicable.
6. If the patient is pregnant or possibly pregnant, indicate this appropriately, and if a CT scan is scheduled, stop here. If it's for an MRI, continue answering the remaining questions.
7. Provide answers to questions about the patient's medical history, including details about prematurity, referrals to nephrologists, dialysis history, transplants, liver diseases, and chemotherapy treatments.
8. Explain the relationship of the person providing history and enter the name of the nurse or provider completing the form along with the date and time.
9. If the answer is 'YES' to any relevant history, a serum creatinine test result is required. Enter the date of the test and the serum creatinine result, along with the calculated GFR.
10. If no recent serum creatinine results are available, make an appropriate order for the test from a healthcare provider and indicate who will be faxing this information.
11. Complete Section B by selecting the IV contrast agent used and include the names and dates of the technologist and radiologist who reviewed the form.
12. After ensuring all sections are filled out correctly, save your changes, then download, print, or share the form as needed.

Complete your forms online to ensure accurate and efficient processing.