Get the free MRI Screening Questionnaire - Pleasanton Diagnostic Imaging
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MRI Screening Questionnaire Patient Name: Sex: DOB: Date: Weight: Height: This questionnaire is designed to assist us in determining if it is safe for you to undergo a magnetic resonance imaging procedure.
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How to fill out mri screening questionnaire
How to fill out mri screening questionnaire
01
Read the instructions provided on the MRI screening questionnaire.
02
Fill in all the requested personal information accurately.
03
Answer each question honestly and to the best of your knowledge.
04
If any question is unclear, seek clarification from the healthcare provider or staff.
05
Provide details of any medical conditions, previous surgeries, or ailments you have experienced.
06
If you have any allergies or adverse reactions to medications, mention them on the questionnaire.
07
Disclose any metal implants, pacemakers, cochlear implants, or other devices in your body.
08
Follow any additional instructions, such as fasting requirements or restrictions on certain activities before the MRI.
09
Once completed, review the questionnaire to ensure all required fields are filled.
10
Submit the filled questionnaire to the appropriate healthcare professional.
Who needs mri screening questionnaire?
01
Individuals scheduled for an MRI scan need to fill out the MRI screening questionnaire.
02
Patients with certain medical conditions or health concerns may be required to complete the questionnaire before undergoing an MRI.
03
Persons who have had previous surgeries or are known to have metal implants in their body often need to fill out the screening questionnaire.
04
Individuals with allergies or adverse reactions to medications should also fill out the questionnaire.
05
Patients who have pacemakers, cochlear implants, or other devices implanted need to complete the MRI screening questionnaire.
06
It is best to consult with the healthcare provider or imaging center to determine if you need to fill out the MRI screening questionnaire.
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