Get Kaiser Permanente Mri Screening Questionnaire 2003-2026

Filling out the Kaiser Permanente MRI Screening Questionnaire is an important step in ensuring your safety and preparedness for the MRI procedure. This guide provides step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the questionnaire successfully.

1. Press the 'Get Form' button to access the MRI Screening Questionnaire in the online editor.
2. Begin by entering your personal information at the top of the form, including your name, Medical Record Number (MRN), and the date of the questionnaire.
3. Answer whether you have had a previous exam related to this problem by selecting ‘Yes’ or ‘No.’ If yes, fill in the 'When' and 'Where' fields.
4. State if you have taken any medications today to reduce anxiety for the MRI exam, answering ‘Yes’ or ‘No.’
5. Confirm if you have ever had surgeries or procedures involving your brain by selecting ‘Yes’ or ‘No,’ and provide necessary details.
6. Complete the MRI Hazard Checklist by indicating whether you have any specific medical devices or conditions by selecting ‘Yes’ or ‘No.’
7. Review the HARD STOP instruction. If any previous responses indicate a 'Yes,' you must hold the MRI and have the ordering physician consult with the Radiologist.
8. Finally, verify the information, sign and date the form at the bottom, and ensure all required fields are completed.

Complete the Kaiser Permanente MRI Screening Questionnaire online to ensure a safe and efficient experience.