Get the free MRI SCREENING QUESTIONNAIRE - Freehold Radiology
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MRI SCREENING QUESTIONNAIRE NAME SEX AGE REFERRING PHYSICIAN DOB WEIGHT HEIGHT PLEASE INDICATE IF YOU HAVE ANY OF THE FOLLOWING: CARDIAC PACEMAKER YES NO BREAST TISSUE EXPANDER YES NO PACING WIRES
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How to fill out mri screening questionnaire
How to fill out MRI screening questionnaire:
01
Start by carefully reading each question on the form. Pay attention to any specific instructions or guidelines provided.
02
Provide accurate and complete personal information, such as your name, contact details, and date of birth.
03
Answer all the questions honestly. MRI screening questionnaires are designed to assess any potential risks or contraindications for undergoing an MRI scan. It is important to disclose any relevant medical conditions, allergies, or previous surgeries that could impact the scan or your safety during the procedure.
04
If you are unsure about any question or need clarification, don't hesitate to ask for assistance from the healthcare provider or staff responsible for the screening process.
05
Double-check your answers before submitting the completed questionnaire to ensure accuracy and completeness.
Who needs MRI screening questionnaire:
01
Individuals scheduled for an MRI scan: MRI screening questionnaires are typically required for anyone scheduled to undergo an MRI. This includes both adults and children.
02
Patients with medical conditions: Individuals with certain medical conditions, such as implanted devices (pacemaker, cochlear implant, etc.), metal fragments in the eyes, or claustrophobia, may require additional screening to ensure safety during the MRI procedure.
03
Healthcare providers and technicians: MRI screening questionnaires may also be necessary for the healthcare providers and technicians involved in conducting the scan. This helps to identify any potential risks or contraindications for both the patients and the staff.
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What is mri screening questionnaire?
MRI screening questionnaire is a form that collects relevant information from individuals undergoing MRI scans to ensure their safety and well-being during the procedure.
Who is required to file mri screening questionnaire?
Any individual scheduled to undergo an MRI scan is required to fill out the MRI screening questionnaire prior to the procedure.
How to fill out mri screening questionnaire?
The MRI screening questionnaire can be filled out by providing accurate information about medical history, allergies, implanted devices, and any other relevant details as requested.
What is the purpose of mri screening questionnaire?
The purpose of the MRI screening questionnaire is to identify any potential risks or contraindications for the individual undergoing the MRI scan, and to ensure their safety during the procedure.
What information must be reported on mri screening questionnaire?
Information such as medical history, allergies, implanted devices, recent surgeries, pregnancy status, and any metal objects or implants in the body must be reported on the MRI screening questionnaire.
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