Get the free MRI EXAM QUESTIONNAIRE

MRI EXAM QUESTIONNAIRE Patient Name: Your exam, (images and report×, will automatically be sent to your Oregon Clinic Doctor Please provide the name of your current Primary Care Physician Would like

How to fill out mri exam questionnaire

Who needs an MRI exam questionnaire?

1. Patients: All patients who are scheduled to undergo an MRI exam are typically required to fill out a questionnaire. This includes individuals who have been referred by their primary care doctor, specialists, or other healthcare providers. The questionnaire helps gather important medical history and information to ensure the safety and accuracy of the MRI procedure.
2. Radiologists and Technologists: The MRI exam questionnaire is also essential for the healthcare professionals performing the MRI. Radiologists and technologists use the information provided in the questionnaire to assess any potential risks, contraindications, or precautions that need to be taken before conducting the scan. This allows them to make informed decisions about the exam and tailor it to the specific needs of each patient.

How to fill out an MRI exam questionnaire:

1. Provide personal information: Begin by filling out your personal details such as your full name, date of birth, address, contact information, and any relevant identification numbers. This information is necessary for identification purposes and to ensure accurate record-keeping.
2. Medical history: Carefully fill out the section on your medical history. This includes any known allergies, previous surgeries, chronic medical conditions, and current medications. Be thorough and include any relevant details as they can impact the MRI exam procedure or the use of contrast agents.
3. Pre-existing conditions: Indicate any pre-existing conditions or implantable devices you may have, such as pacemakers, cochlear implants, or metal implants in the body. These conditions or devices could potentially interfere with the MRI exam, so it is crucial to disclose them to ensure your safety during the procedure.
4. Pregnancy or breastfeeding: If you suspect you might be pregnant or are currently breastfeeding, inform the healthcare provider conducting the MRI exam. These conditions may require additional precautions, as some aspects of the MRI may pose potential risks to the developing fetus or the lactation process.
5. Contrast agents: If your MRI exam requires the use of contrast agents, answer the questions regarding previous reactions to contrast agents, such as allergic reactions or kidney-related issues. This information is vital for the radiologist to determine the appropriate contrast agent or whether it should be used at all.
6. Additional information: At the end of the questionnaire, there may be a section for you to provide any additional details, concerns, or questions you may have. Feel free to utilize this space to communicate any specific issues you think the healthcare provider should be aware of.

Remember, the accuracy and thoroughness of the information you provide in the MRI exam questionnaire are crucial for your safety and the effectiveness of the procedure. If you are unsure about any questions, it is always best to consult with the healthcare provider conducting the MRI exam.

For pdfFiller’s FAQs

How can I manage my mri exam questionnaire directly from Gmail?

Using pdfFiller's Gmail add-on, you can edit, fill out, and sign your mri exam questionnaire and other papers directly in your email. You may get it through Google Workspace Marketplace. Make better use of your time by handling your papers and eSignatures.

Can I edit mri exam questionnaire on an iOS device?

Create, edit, and share mri exam questionnaire from your iOS smartphone with the pdfFiller mobile app. Installing it from the Apple Store takes only a few seconds. You may take advantage of a free trial and select a subscription that meets your needs.

How do I complete mri exam questionnaire on an Android device?

Use the pdfFiller Android app to finish your mri exam questionnaire and other documents on your Android phone. The app has all the features you need to manage your documents, like editing content, eSigning, annotating, sharing files, and more. At any time, as long as there is an internet connection.