VA VCU Medical Center MRI Request Form 2012-2025 free printable template

Date: / / Patient Name: MR#: DOB: / / Age: Department of Radiology MRI Request Form Requested location for exam: Height: ft in Weight: lbs Gender: M F Insurance Information Insurance Name: MTV Campus

How to fill out VA VCU Medical Center MRI Request

How to fill out VA VCU Medical Center MRI Request Form

1. Obtain the VA VCU Medical Center MRI Request Form from the healthcare provider's office or the VA website.
2. Fill in the patient's identification details, including name, date of birth, and social security number.
3. Provide the referring physician's information, including name, contact number, and the clinic address.
4. Select the specific MRI procedure required by marking the appropriate box on the form.
5. Indicate any relevant medical history or specific concerns that may affect the MRI process.
6. Ensure that all required signatures are completed, including the patient's and the referring physician's.
7. Double-check the form for completeness and accuracy before submitting.
8. Submit the form to the VA VCU Medical Center via fax, email, or in-person delivery as directed.

Who needs VA VCU Medical Center MRI Request Form?

1. Patients who require an MRI as part of their medical evaluation or treatment plan.
2. Referring physicians who need to facilitate MRI services for their patients.
3. Healthcare providers within the VA system coordinating care for veterans.

People Also Ask about

Can I drink water before MRI with contrast?

You should not eat or drink anything 4 hours prior to your exam time. You may take your medications with a small sip of water if needed. The day before your exam drink plenty of water so you are well hydrated. Being hydrated will ease the discomfort for those receiving contrast.

Can I drink coffee before MRI with contrast?

What Should I Do Before My MRI? It's important not to drink a lot of caffeine before your MRI because caffeine will make your blood vessels constrict. If your scan is monitoring blood flow, constricted blood vessels will give you inaccurate results.

Do you have to fast for an abdominal MRI with contrast?

You will be asked to fast for 4 hours prior to your exam. You may take your usual medications with small amounts of water. Otherwise, no additional preparation is needed.

What format is MRI data?

CT and MRI images are acquired in a special digital format, called the DICOM format. DICOM ensures that the high quality of the images is retained.

Why do you have to fast before MRI with contrast?

Radiologists recommend fasting prior to undergoing a CT or MRI with contrast because of the possible side effects of the contrast agents. While rare, side effects of contrast can cause nausea or vomiting during the test. Vomiting while lying down could cause food blockages in your airway, known as asphyxia.

Can I eat or drink before an MRI with contrast?

Eating before your appointment If you are getting intravenous contrast material, which helps your body part show up better in the MRI pictures, or sedative medicine during the examination, you may be asked to not eat solid food for four to eight hours before the examination.

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What is VA VCU Medical Center MRI Request Form?

The VA VCU Medical Center MRI Request Form is a document used by healthcare providers to request magnetic resonance imaging (MRI) scans for patients within the VA VCU Medical Center healthcare system.

Who is required to file VA VCU Medical Center MRI Request Form?

Healthcare providers, including physicians and specialists, are required to file the VA VCU Medical Center MRI Request Form on behalf of their patients when an MRI is deemed necessary for diagnosis or treatment.

How to fill out VA VCU Medical Center MRI Request Form?

To fill out the VA VCU Medical Center MRI Request Form, the healthcare provider must complete patient identification details, specify the requested MRI procedure, provide clinical information supporting the request, and sign the form before submission.

What is the purpose of VA VCU Medical Center MRI Request Form?

The purpose of the VA VCU Medical Center MRI Request Form is to ensure proper authorization and documentation for MRI procedures, facilitating accurate medical imaging services for patients.

What information must be reported on VA VCU Medical Center MRI Request Form?

The information that must be reported includes patient demographics (name, date of birth, ID number), the specific MRI procedure requested, clinical history or reason for the MRI, and any relevant prior imaging results.