Get the free MRI Upper Extremity Screening Questionnaire 3 pages

PAUL A. COOK, M.D. CHARON GOLDA, M.D. RAYMOND J. KOB US, M.D. MRI Screening Questionnaire Patient Name: LAWRENCE M. LUBBERS, M.D. JAMES F. NAPPY, M. D MEAGAN FAY, C.N.P. R.N.F.A Date: Patient Phone:

How to fill out mri upper extremity screening

How to fill out MRI upper extremity screening:

1. Start by gathering all necessary information about the patient, including their personal details, medical history, and any relevant previous imaging results.
2. Begin by completing the patient's demographic information, such as their full name, date of birth, and contact details.
3. Next, provide information about the ordering physician, including their name, contact information, and any specific instructions they may have given for the screening.
4. Proceed to document the reason for the MRI upper extremity screening. This could include any symptoms or concerns the patient is experiencing that require further evaluation.
5. Record any relevant medical history that may impact the screening, such as previous injuries, surgeries, or medical conditions.
6. Specify the relevant upper extremity being screened (e.g., right or left arm, shoulder, or wrist) and provide a brief description of the patient's symptoms or concerns for that particular area.
7. If there are any specific imaging techniques or protocols recommended by the ordering physician, make sure to include that information in the appropriate section.
8. In the "Contrast" section, indicate whether contrast administration is necessary and provide any relevant details, such as allergies or previous adverse reactions to contrast media.
9. Complete any additional sections or questions as required by the specific MRI upper extremity screening form, following the given instructions accurately.
10. Review the completed form for accuracy and completeness before submitting it for imaging.

Who needs MRI upper extremity screening:

1. Individuals experiencing persistent or unexplained pain in the upper extremity, such as the shoulder, arm, or wrist, may require an MRI upper extremity screening. This could be due to various causes, including trauma, overuse, or underlying medical conditions.
2. Patients with suspected joint or soft tissue abnormalities in the upper extremity, such as rotator cuff tears, ligament or tendon injuries, or arthritis, may be candidates for MRI screening.
3. Individuals with unexplained swelling, limited range of motion, or functional impairments in the upper extremity may also benefit from MRI screening to help diagnose and guide appropriate treatment.
4. Physicians may order MRI upper extremity screening for patients who have not responded to conservative treatments, such as physical therapy or medication, to further investigate the underlying cause of their symptoms.
5. MRI screening can also be useful in pre-operative planning, providing detailed anatomical information to help guide surgical interventions in the upper extremity.
6. It is essential to consult with a healthcare provider or an orthopedic specialist to determine whether MRI upper extremity screening is necessary and appropriate for an individual's specific condition or symptoms.

For pdfFiller’s FAQs

What is mri upper extremity screening?

MRI upper extremity screening is a medical procedure that uses magnetic resonance imaging to examine the structures in the upper extremities, such as the shoulders, arms, and hands.

Who is required to file mri upper extremity screening?

Patients who have been recommended for an MRI upper extremity screening by their healthcare provider are required to undergo the procedure.

How to fill out mri upper extremity screening?

To fill out an MRI upper extremity screening, patients typically need to provide their personal information, medical history, and any relevant symptoms or concerns.

What is the purpose of mri upper extremity screening?

The purpose of MRI upper extremity screening is to diagnose and evaluate conditions affecting the upper extremities, such as fractures, tears, inflammation, and other abnormalities.

What information must be reported on mri upper extremity screening?

Information that must be reported on an MRI upper extremity screening includes the patient's name, date of birth, referring physician, specific symptoms or concerns, and any relevant medical history.

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