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2101 W Arlington Blvd, Suite 100, Greenville, NC 27834 Open Mon Fri 8am5pm Tues 8am7pm 252.752.5000 www.easternrad.com Patient Name DOB / / Date / / MAN QUESTIONNAIRE: BREAST MRI Weight: Height: Bra
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Questionnaire breast MRI is a form used to gather information about a patient's medical history and risk factors related to breast cancer before undergoing a breast MRI scan.
Patients who are scheduled to undergo a breast MRI scan are required to fill out the questionnaire.
Patients can fill out the questionnaire by providing accurate and detailed information about their medical history, family history of breast cancer, and any breast symptoms they may have.
The purpose of the questionnaire is to help healthcare providers assess the patient's risk factors for breast cancer and ensure the effectiveness and safety of the breast MRI scan.
The questionnaire usually asks for information such as medical history, family history of breast cancer, breast symptoms, and any previous breast imaging studies.
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