Get the free New MRI Screening Sheet 12 - Hampton Roads Orthopaedics

Open MultiPositional MRI SCREENING SHEET Patient Name: Date: Appointment Date: Phone: DOB: Weight: Referring Physician: Is this your first MRI?: Are you using a walker, wheelchair or cane?: If no,

How to fill out new mri screening sheet

How to fill out a new MRI screening sheet:

1. Begin by carefully reading the instructions provided on the MRI screening sheet. Familiarize yourself with the purpose of the form and the information it requires.
2. Start by providing your personal details like your full name, date of birth, and contact information. This ensures that the medical personnel can easily identify you and reach out if needed.
3. The next section usually involves your medical history. Be thorough and accurate when filling out this section, as it helps the healthcare provider determine any potential risks or contraindications for the MRI scan. Include details about any current medications, allergies, previous surgeries, and any existing medical conditions.
4. If applicable, you may be asked to disclose any implanted devices or metallic objects in your body that might interfere with the MRI scan or cause harm. This could involve things like pacemakers, cochlear implants, or metal fragments. Make sure to provide all the necessary information accurately.
5. In some cases, there might be specific questions related to your health or recent activities that could impact the MRI procedure. Answer these questions truthfully and to the best of your knowledge, as it helps ensure your safety during the scan.
6. Finally, carefully review the information you have provided on the MRI screening sheet. Double-check for any errors or omissions. If everything looks accurate, sign and date the form to indicate that you have completed it truthfully.

Who needs a new MRI screening sheet?

1. Individuals who have been scheduled for an MRI scan at a medical facility usually need to fill out a new MRI screening sheet. This ensures that the healthcare providers have updated and accurate information about the patient's health status before performing the scan.
2. Patients who have never undergone an MRI scan before or those who haven't had one in a considerable amount of time may need to complete the screening sheet to provide an updated medical history and identify any potential risks or contraindications.
3. In some cases, patients who have experienced significant changes in their health since their last MRI scan may be required to complete a new screening sheet to provide the healthcare professionals with detailed information about their current condition. This helps in ensuring their safety during the procedure.

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