Get Hc 936 Radiology Preg Release.pdf - University Of California, Santa ... - Shs-manual Ucsc

Filling out the HC 936 Radiology Pregnancy Release form is a crucial step for female patients of childbearing age before undergoing X-ray procedures. This guide will provide you with comprehensive, step-by-step instructions to ensure the form is completed accurately and effectively.

Follow the steps to complete the HC 936 Radiology Pregnancy Release form.

1. Click the ‘Get Form’ button to obtain the document and open it in the designated editor.
2. Begin by entering your name in the designated field. Ensure that you spell your name correctly, as this will be associated with your medical records.
3. In the next field, input your Student Identification Number (SID). This number helps to uniquely identify your record within the University’s systems.
4. Next, provide the date on which you are filling out the form. This information is important for record-keeping purposes.
5. Answer the questions regarding your menstrual cycle and pregnancy possibility. The first question asks for the first day of your last normal menstrual period. Fill this in accurately.
6. Respond to the question about whether you are, or could be, pregnant by selecting 'Yes,' 'No,' or 'Unsure.' This is a crucial question as it affects the procedure you are about to undergo.
7. Specify your method of birth control in the designated space. If you are not using birth control, indicate whether you have had penetrative heterosexual intercourse since your last menstrual period by answering 'Yes' or 'No.'
8. In the signature field, sign your name to acknowledge that you have been informed of the risks associated with radiation exposure during pregnancy and assume responsibility for any consequences.
9. Finally, enter the date of your signature. Once all fields are completed, you can save your changes, download, print, or share the form as necessary.

Complete your HC 936 Radiology Pregnancy Release form online today to ensure a smooth process for your upcoming X-ray exam.