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MRI Patient Screening Questionnaire and Consent Form SURNAMEFIRST NAMED ATE OF BIRTHCHIHEIGHTWEIGHTADDRESSHOME TEL1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. Question Do you have a CARDIAC PACEMAKER
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01
Start by reading each question in the MRI patient screening questionnaire carefully.
02
Answer each question honestly and to the best of your knowledge.
03
If you are unsure about any question, ask the healthcare professional or staff assisting you.
04
Provide accurate and detailed information as required, such as your medical history, current medications, allergies, and any previous surgeries.
05
Take your time to ensure that you have filled out all sections of the questionnaire thoroughly.
06
Double-check your answers for accuracy before submitting the completed questionnaire.
07
If you have any concerns or need further assistance, don't hesitate to ask for help.

Who needs mri patient screening questionnaire?

01
Anyone who is scheduled for an MRI (Magnetic Resonance Imaging) scan needs to fill out the MRI patient screening questionnaire. This includes individuals who have been referred by their healthcare provider for diagnostic imaging or those who have received a prescription for an MRI.
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The MRI patient screening questionnaire is a form used to gather information about patients before undergoing an MRI scan.
Patients who are scheduled to undergo an MRI scan are required to fill out the screening questionnaire.
Patients can fill out the MRI patient screening questionnaire by providing accurate and complete information about their medical history, current medications, and any metal implants or devices.
The purpose of the MRI patient screening questionnaire is to ensure the safety of the patient during the MRI scan and to prevent any potential harm from metal objects or medical conditions.
The MRI patient screening questionnaire must include information about the patient's medical history, current medications, allergies, metal implants, and any other relevant information for the MRI technologist to review.
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