FEMALE 8. The following items can interfere with the MRI and some may actually be hazardous to your safety. Please check all that apply: Aneurysm clip(s) (e.g., brain) Implanted Cardiac Defibrillator/Pacemaker Neurostimulator Biostimulator Type: __________________ Tattoos or Tattooed Eyeliner Tissue Expander (e.g., Breast) Any Type of Internal Electrodes or Wires Wig, Hair Implants Cochlear (Ear) Implant Artificial Heart Valve Hearing Aid Any Type of Implant Held in Place by a Magnet Type.
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How to fill out the MAMC 1527-X online
The MAMC 1527-X form is essential for initiating the magnetic resonance imaging (MRI) process. This guide will help you understand each section of the form and provide clear instructions on how to complete it online, ensuring a smooth and efficient experience.
Follow the steps to effectively complete the MAMC 1527-X form.
- Press the ‘Get Form’ button to retrieve the MAMC 1527-X form and have it displayed on your preferred device for filling out.
- Begin by entering your full name in the designated field at the top of the form. This identifies you as the person undergoing the MRI.
- Input the sponsor's social security number in the relevant section. This is necessary for processing your medical information.
- Select your sex by marking either the 'Male' or 'Female' option clearly.
- Provide your home phone number and work phone number in the specified fields to ensure effective communication regarding your MRI.
- Fill in your weight and height in the respective sections; this information helps in conducting a safe and accurate scan.
- Review the list of items that may interfere with your MRI. Check all that apply to your situation to ensure safety during the procedure.
- Answer the questions about previous injuries, surgeries, allergies, and other health conditions as accurately as possible.
- Sign and date the form at the bottom, confirming that the information provided is correct to the best of your knowledge.
- Ensure you have saved your changes before exiting. You can then download, print, or share the completed form as needed.
Complete your MAMC 1527-X form online today for a hassle-free MRI process.
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