Get the free SJRA MRI Hx Form

MRI Breast Patient Information Exam date Patient name DOB ? Female ? Male Height Weight If patient is a minor, parent s name 1. Is there any chance of pregnancy? ? Y 2. Are you currently breastfeeding?

How to fill out sjra mri hx form

How to Fill Out SJRA MRI HX Form:

1. Start by carefully reading the instructions provided on the form. Make sure you understand all of the sections and what information is required.
2. Begin by filling out the personal information section. This typically includes your name, date of birth, address, and contact information. Provide accurate and up-to-date information.
3. Move on to the medical history section. Here, you will be asked to provide details about any pre-existing conditions, past surgeries, allergies, medications you are currently taking, and any other relevant medical information.
4. Pay attention to any specific questions or prompts on the form. For example, you may be asked about any metal implants or devices in your body, as these can interfere with MRI imaging.
5. If you have any questions or are unsure about how to answer a particular question, don't hesitate to ask for assistance. You want to ensure that you provide accurate and complete information on the form.
6. Once you have completed all the necessary sections, review the form for any errors or omissions. Double-check that you have provided all the required information.
7. Sign and date the form as instructed. This shows that you have completed it and that the information provided is true and accurate.

Who Needs SJRA MRI HX Form:

1. Individuals who are scheduled to undergo an MRI (Magnetic Resonance Imaging) scan at SJRA (South Jersey Radiology Associates) may need to fill out the SJRA MRI HX form.
2. This form helps the healthcare providers gather essential medical history information that could impact the MRI scanning process or the interpretation of the results.
3. Patients who have any pre-existing medical conditions, surgeries, allergies, or are taking medications that could potentially interfere with the MRI procedure may be required to fill out this form.
4. It is also necessary for individuals with metal implants or devices, such as pacemakers or cochlear implants, as these can have implications for the MRI scan.
5. The SJRA MRI HX form ensures that the healthcare team has all the necessary information to provide safe and accurate imaging services tailored to the patient's specific needs.

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