Get Modulo Per Richiesta Di Esame Di Risonanza Magnetica - Ulss 22 - Docvadis

Filling out the Modulo Per Richiesta Di Esame Di Risonanza Magnetica can be a straightforward process when approached step by step. This guide will provide clear and supportive instructions for users looking to complete this important medical form online.

Follow the steps to successfully fill out the form.

1. Click the 'Get Form' button to obtain the form and open it in a new window.
2. Fill in the personal information fields at the top of the form, including surname, first name, and date of birth. Ensure the accuracy of the data entered.
3. Indicate the patient's current hospitalization status by filling in the relevant field—either for admitted patients or for outpatient requests.
4. In the anamnesis section, provide a brief medical history relevant to the MRI request.
5. List any previous diagnostic tests and their results in the designated space to inform the healthcare provider about prior investigations.
6. State the clinical question and specify the MRI examination requested as well as the name of the referring physician.
7. Complete the preliminary questionnaire regarding contraindications by marking 'yes' or 'no' for each item listed. Check for any absolute or relative contraindications.
8. If applicable, sign the consent section acknowledging understanding of the procedure and any potential risks associated with it.
9. Finally, include the date and signature of the patient or the individual giving consent, as well as the stamp and signature of the referring doctor.
10. After completing the form, you can save your changes, download, print, or share the document as needed.

Start filling out your form online now to ensure a smooth process for your MRI request.