Get Incomplete Forms Will Be Returned Request For Mri Consultation

Filling out the Request for MRI Consultation form correctly is crucial to ensuring your consultation proceeds smoothly. This guide provides clear, step-by-step instructions on how to complete the form online accurately.

Follow the steps to successfully complete your MRI consultation request form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred document editor.
2. In the Patient Information section, provide the referring physician's details. Ensure you fill in the last name, first name, and any applicable gender designation. Include the patient's address, health card number, city, province, and telephone number. If the patient is an outpatient or inpatient, make sure to select the correct option as well as the date of birth in the format dd/mmm/yyyy.
3. Complete the isolation precaution section by providing necessary contact details of the referring physician, as well as details regarding MRI report copies.
4. Answer the patient safety questions carefully. Ensure to check 'Yes' or 'No' as appropriate for each question regarding medical history or current conditions. Specifics regarding allergies, the need for an interpreter, or physical assistance should be clearly indicated.
5. Provide detailed information regarding the type of MRI exam requested and any significant history or diagnosis relevant to the procedure. Be specific about the examination you are requesting.
6. For the renal assessment, indicate if any applicable conditions are present. If the patient has had any procedures or devices implanted, make sure to provide their make, model, and implant date.
7. Finally, attest to the accuracy of the information provided by signing the form. Identify who completed the form by including their printed name, relationship to the patient, appointment time, and date.
8. After reviewing the completed form for any errors, you may save changes, download, print, or share the finished MRI consultation request form as needed.

Complete your MRI consultation request form online today for efficient processing.