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Get Kaiser Permanente Mri Screening Questionnaire 2003-2025

Name: MAN #: Date:MRI Screening QuestionnaireWeight: kg Height: Please explain the reason for this MRI scan/procedure? Have you had a previous exam related to this problem? Yes No When: Where: Personal.

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Because of this magnetic field and the associated radiofrequency energy, providing MRI screening for patients and staff is critical to their individual safety. Screening ensures that no ferromagnetic objects or objects (in or on anyone) that conduct electricity enter the magnetic resonance (MR) scanning area.

Pre-screening Process This requires a brief questionnaire about your health history. For example this may include questions pertaining to implantable devices such as a pacemaker, recent surgery, pregnancy, or if you are a metal worker. You can also choose to download and complete our MRI pre-screening form.

The MRI questionnaire is designed to identify all potential implants and/or foreign bodies that the patient has. These are then assessed to decide whether there is a risk involved in scanning the patient. In cases where implants are common or well-known, radiographers will decide whether imaging can proceed.

Is there any possibility that you are, or may be, pregnant? Are you currently breastfeeding? Do you have an implanted IUD? Have you had any problems during prior MRI scans?

Does the patient have any metal implants, surgical clips (including aneurysm clips), valves, Has the patient worked around metal or have a history of metal fragments in eyes? ... Does the patient require sedation for claustrophobia, pain control or motion control?

Individuals undergoing an MRI procedure must remove all readily removable metallic personal belongings and devices on or in them (e.g., watches, jewelry, body piercing if removable, contraceptive diaphragms), metallic drug delivery patches, and clothing items which may contain, metallic fasteners, hooks, zippers, loose ...

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232