Get Patient Procedure Screening Form - Massachusetts General Hospital - Massgeneral

This guide provides step-by-step instructions on how to effectively fill out the Patient Procedure Screening Form at Massachusetts General Hospital. Completing this form online ensures that you provide accurate and comprehensive information for your MRI procedure.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editing tool.
2. Fill in the date at the top of the form, ensuring it accurately reflects the current date.
3. Enter your Massachusetts General Hospital medical record number. This number helps the hospital track your medical history effectively.
4. Complete your personal information including your full name, last name, first name, and middle initial.
5. Input your date of birth. This information is critical for identifying your medical records.
6. Indicate your gender by selecting 'Male' or 'Female.' Provide your age, height, and weight where prompted.
7. Specify the body part that is to be examined and note if applicable whether it is the left or right side.
8. Detail the reason for your MRI and any symptoms you are experiencing. Be as specific as possible to assist the medical staff.
9. Respond to the questions regarding any potential implants or devices that could affect the MRI procedure.
10. Answer all medical history questions including conditions such as diabetes, cancer history, and if you have had any previous MRI scans.
11. Provide information regarding any medications or allergies, including reactions to contrast material, if applicable.
12. For female patients, answer questions related to pregnancy, menstrual periods, and hormonal treatments.
13. Review the important instructions about changing into hospital-provided clothing and removing metallic objects prior to entering the MRI scan room.
14. Affix your signature to attest that the information provided is accurate and complete. Include the date and indicate who completed the form.
15. Once completed, users can save changes to the form, download a copy for their records, print the form, or share it with healthcare providers as needed.

Complete your Patient Procedure Screening Form online to facilitate your upcoming MRI.