Get Dri Mri Patient History & Consent Form 2015-2025

Filling out the DRI MRI Patient History & Consent Form online is an essential step in ensuring that you receive safe and effective medical imaging services. This guide provides comprehensive instructions on completing the form accurately, helping you understand each component along the way.

Follow the steps to complete your patient history and consent form.

1. Click ‘Get Form’ button to obtain the DRI MRI Patient History & Consent Form, and open it in your preferred editor.
2. Begin by entering your personal information, such as your name, medical record number, imaging center, date of exam, and body part to be examined. Accurate information is important for your medical records.
3. Indicate the reason for the MRI examination and provide the name and phone number of the referring physician. This helps the medical staff to understand the context of your imaging.
4. Fill in your date of birth, age, height, and weight. This data is crucial for assessing your medical history and ensuring a safe imaging process.
5. If applicable, indicate whether you are postmenopausal and check your gender. Detail your last menstrual period if you are female, as this may impact the procedure.
6. Answer questions regarding any anxiety or sedation medication you may have taken. This is important for the safety of your MRI.
7. Respond to the section regarding any previous injuries involving metal or existing metallic implants. This information is critical for ensuring your safety during the MRI.
8. Review the list of surgical implants and check the relevant boxes to indicate which, if any, apply to you. This includes items such as cardiac pacemakers, stents, and artificial limbs.
9. Indicate your pregnancy status and breastfeeding status, if relevant. This is imperative for selecting the proper imaging protocol.
10. Answer the contrast consent questions, particularly regarding any allergies and kidney health. Indicate your preferences regarding the Gadolinium contrast media.
11. Finally, review all the information filled out, then provide your signature and date at the bottom of the form. Ensure any guardian signatures are provided if necessary.
12. After completing the form, save your changes. You may also choose to download, print, or share the form as needed.

Take the steps to fill out your documents online today for a smooth MRI experience!