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Patient Name: Pt. Weight lbs. MAGNETIC RESONANCE IMAGING MRI SAFETY CHECKLIST & CONSENT FORM CONTRAINDICATIONS: Yes Yes No No No No Do you have metal in your eyes? Aneurysm clip s) in your head? A
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How to fill out an MRI consent form:

01
Begin by carefully reading the entire consent form to understand its purpose and the information it requires.
02
Provide your personal details accurately, including your full name, date of birth, and contact information.
03
Next, disclose any relevant medical history, such as allergies, current medications, or previous surgeries that may affect the MRI procedure.
04
Review the risks and benefits section of the form. Make sure you understand the potential side effects or complications associated with undergoing an MRI.
05
Consider any specific concerns or questions you may have and discuss them with the medical staff or your healthcare provider.
06
Sign and date the form to indicate your informed consent to proceed with the MRI procedure.
07
Return the completed consent form to the relevant healthcare professional or facility prior to your scheduled MRI appointment.

Who needs an MRI consent form:

01
Patients who are scheduled to undergo an MRI scan need to fill out an MRI consent form. This includes individuals experiencing specific medical conditions or those who are being evaluated for possible health issues.
02
In certain cases, minors may need to have a parent or guardian complete the form on their behalf since they are unable to provide informed consent themselves.
03
The MRI consent form is crucial for establishing open communication between the healthcare provider and the patient, ensuring that the patient understands the procedure, associated risks, and gives their consent for the scan to be performed.
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MRI consent form is a document that allows a patient to give consent for a magnetic resonance imaging (MRI) scan.
The patient who is scheduled to undergo an MRI scan is required to fill out the MRI consent form.
To fill out the MRI consent form, the patient must provide their personal information, sign the form, and indicate their consent for the MRI scan.
The purpose of the MRI consent form is to ensure that the patient understands the risks and benefits of the MRI scan and consents to the procedure.
The MRI consent form must include the patient's name, date of birth, contact information, relevant medical history, and consent for the MRI scan.
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