Get Canada Alberta Health Services Lumbar Spine Imaging Screening Record 2017-2026
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How to fill out the Canada Alberta Health Services Lumbar Spine Imaging Screening Record online
Filling out the Canada Alberta Health Services Lumbar Spine Imaging Screening Record is an essential step in facilitating your lumbar spine imaging request. This guide will provide you with clear, step-by-step instructions to ensure that all necessary information is accurately submitted.
Follow the steps to complete your screening record.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Enter your last name and first name in the respective fields to identify yourself clearly.
- Provide your birthdate in the format yyyy-Mon-dd. This information is important for verifying your identity.
- Select your gender from the options provided. This might be required for demographic purposes.
- Input your Personal Health Number, as this is crucial for processing your request.
- Fill in your daytime phone number for contact purposes.
- Indicate your age to help assess your needs accurately.
- Print the first and last name of the referring physician to ensure that the request is properly directed.
- Answer whether an MRI or CT was previously recommended, choosing either 'Yes' or 'No'. If 'Yes', be sure to include a copy of the report.
- Respond to whether symptoms are severe enough to consider surgery, selecting from 'Yes', 'No', or 'Not Applicable'.
- Specify the duration of symptoms by selecting one of the provided time ranges.
- Choose the pain type: 'Back Dominant Pain' or 'Leg Dominant Pain, Sensory Radiculopathy'.
- Indicate if there is objective motor weakness in the lower extremity by selecting 'Yes' or 'No'.
- Respond to whether typical neurogenic claudication symptoms are present by selecting 'Yes' or 'No'.
- Assess for any 'Red Flags' present, selecting 'Yes' or 'No' based on the symptoms described.
- Answer questions about unexplained weight loss, fever, immunosuppression, or history of cancer, using 'Yes' or 'No'.
- Indicate if there have been any acute traumatic events leading to your current symptoms.
- Select 'Yes' or 'No' for experiencing severe unremitting worsening of pain at night and when lying down.
- Highlight if you are over 65 years old with your first episode of severe back pain.
- Determine if there are symptoms of Cauda Equina Syndrome and mark 'Yes' or 'No'.
- Once all sections are complete, ensure to save your changes. You may also download, print, or share the form as necessary.
Complete your Canada Alberta Health Services Lumbar Spine Imaging Screening Record online today.
For a lumbar spine MRI, you should lay flat on your back with your arms at your sides. This position not only remains comfortable but also facilitates the best imaging outcome. Adhering to this guidance is crucial for obtaining useful images within the Canada Alberta Health Services Lumbar Spine Imaging Screening Record, which ultimately aids in your diagnosis and treatment.