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Boulder MRI, Suite 105, 1000 W South Boulder Rd, Lafayette, CO 80026 Screening Form Name:DOB:Height/Weight:Gender: MF Describe symptoms you are experiencing: MRI TECHNOLOGIST CLINICAL NOTES (Patient
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01
To fill out an MRI screening form-1, follow these steps:
02
Start by writing your personal information, such as your full name, date of birth, and contact information.
03
Provide information about your medical history, including any previous surgeries, allergies, or medical conditions.
04
Answer questions about any metal or electronic implants you may have, as these can interfere with the MRI scan.
05
Indicate if you have any tattoos or body piercings that contain metal.
06
Specify if you are pregnant or breastfeeding, as this may affect the procedure.
07
If you are taking any medications, list them and their dosages.
08
Sign and date the form to confirm the accuracy of the information provided.

Who needs mri screening form-1?

01
MRI screening form-1 is required for individuals who are scheduled to undergo an MRI (Magnetic Resonance Imaging) scan.
02
It is necessary for patients to provide information about their medical history, implants, and other relevant details to ensure the safety and effectiveness of the procedure.
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MRI Screening Form-1 is a document required for patients to disclose relevant health information prior to undergoing MRI procedures.
Patients scheduled for an MRI are required to file MRI Screening Form-1.
To fill out MRI Screening Form-1, patients must provide personal information, medical history, and answer specific questions regarding their health status and any implants or devices.
The purpose of MRI Screening Form-1 is to ensure patient safety by identifying any potential contraindications for MRI procedures.
The form requires reporting personal identification details, medical history, allergies, current medications, and any prior surgeries or implants.
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