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UC DAVIS RESEARCH IMAGING CENTER PRE-MRI SCREENING QUESTIONNAIRE Date / / Principal Investigator: Name Height Weight Last name First name M.I. Birth Date Social Security No. / / Address City State
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What is pre-mri screening questionnaire form?
The pre-MRI screening questionnaire form is a document that individuals need to complete before undergoing an MRI scan. It includes questions about medical history, current medications, and any potential contraindications for the procedure.
Who is required to file pre-mri screening questionnaire form?
Any individual scheduled to undergo an MRI scan is required to fill out the pre-MRI screening questionnaire form. This includes patients of all ages, unless specified otherwise by the healthcare provider.
How to fill out pre-mri screening questionnaire form?
To fill out the pre-MRI screening questionnaire form, you need to provide accurate and complete information about your medical history, current medications, and any specific conditions or implants that may affect the MRI scan. It is important to answer all the questions truthfully and to the best of your knowledge.
What is the purpose of pre-mri screening questionnaire form?
The purpose of the pre-MRI screening questionnaire form is to gather important medical information from the patient before undergoing the MRI scan. This helps healthcare providers assess any potential risks or contraindications, ensuring the safety and effectiveness of the procedure.
What information must be reported on pre-mri screening questionnaire form?
The pre-MRI screening questionnaire form typically asks for information such as your medical history, allergies, current medications, previous surgeries, presence of any metal implants or devices, kidney function, and pregnancy status. This information is vital for the healthcare provider to make informed decisions regarding the MRI scan.
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