Get the free MRI EXAM REQUEST

Radiology Associates, Inc. MRI EXAM REQUEST Misstate Medical Center High Field 1.5T Open MRI (up to 550 lbs) 435 Lewis Avenue Meriden, CT 06451 Hours: Mon – Fri 6:00 am — 10:00 pm Phone: 203-694-8459

How to fill out mri exam request

How to fill out an MRI exam request:

1. Gather the necessary information: Before starting the form, make sure you have all the required information. This may include the patient's name, date of birth, medical history, contact details, and relevant insurance information.
2. Contact the MRI facility: Reach out to the specific MRI facility where you plan to schedule the exam. They will provide you with the appropriate request form or guide you on how to fill it out. It is important to ensure you have the correct form as different facilities may have different requirements.
3. Begin with the patient information: Start by filling out the patient's name, date of birth, address, and contact details. Double-check for accuracy as any mistakes could cause delays or confusion.
4. Provide medical history: Include relevant medical history, including any previous surgeries, allergies, or existing medical conditions that may be important for the radiologist to know. This information helps to ensure a safe and effective MRI examination.
5. Indicate the reason for the MRI: Describe the symptoms or medical condition that necessitates the MRI. Be as specific as possible, providing details such as the area of concern, duration of symptoms, and any relevant events that may have led to the request.
6. Include referring physician details: Provide the name, contact information, and specialty of the healthcare professional who is referring the patient for the MRI exam. This information is crucial for the radiologist to communicate the results effectively.
7. Insurance and authorization: If applicable, fill in the insurance information, including policy number, group number, and any pre-authorization details that may be required by the insurance company. Some facilities may request a copy of the insurance card, so be prepared to provide that if necessary.

Who needs an MRI exam request:

1. Patients with specific symptoms: Individuals experiencing symptoms such as unexplained pain, swelling, limited mobility, or other concerning issues may require an MRI exam request. This helps healthcare professionals investigate possible underlying conditions.
2. Patients with known medical conditions: People with certain medical conditions, such as cancer, multiple sclerosis, or spinal abnormalities, may need regular MRI examinations to monitor the progression of the disease or assess treatment effectiveness.
3. Patients with prior injuries: MRI exams can be helpful in diagnosing and monitoring the recovery of patients who have experienced previous injuries, such as fractures, ligament tears, or head trauma.
4. Patients requiring surgical planning: Surgeons may request an MRI exam to obtain detailed images of the affected area before planning a surgical procedure. This enables them to assess the structure and severity of the condition, aiding in surgical decision-making.

Remember, it is essential to consult with a healthcare professional to determine if an MRI exam is necessary and to receive guidance on filling out the request form accurately.

For pdfFiller’s FAQs

How can I modify mri exam request without leaving Google Drive?

People who need to keep track of documents and fill out forms quickly can connect PDF Filler to their Google Docs account. This means that they can make, edit, and sign documents right from their Google Drive. Make your mri exam request into a fillable form that you can manage and sign from any internet-connected device with this add-on.

How do I make changes in mri exam request?

The editing procedure is simple with pdfFiller. Open your mri exam request in the editor. You may also add photos, draw arrows and lines, insert sticky notes and text boxes, and more.

Can I edit mri exam request on an Android device?

You can. With the pdfFiller Android app, you can edit, sign, and distribute mri exam request from anywhere with an internet connection. Take use of the app's mobile capabilities.

What is mri exam request?

MRI exam request is a formal document submitted to a medical facility to schedule a magnetic resonance imaging (MRI) scan for a patient.

Who is required to file mri exam request?

Typically, a healthcare provider such as a doctor or specialist is required to file an MRI exam request on behalf of their patient.

How to fill out mri exam request?

To fill out an MRI exam request, the healthcare provider needs to provide patient information, reason for the scan, and any relevant medical history.

What is the purpose of mri exam request?

The purpose of an MRI exam request is to help diagnose and monitor conditions by capturing detailed images of the inside of the body.

What information must be reported on mri exam request?

The MRI exam request should include patient's name, date of birth, reason for the scan, referring provider information, relevant medical history, and insurance details.