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MRI Request & Safety Form Paul Strickland Scanner Centre Mount Vernon Hospital Northwood Middx HA6 2RN Tel: 01923 886311 Fax: 01923 886313 Trial name/no.___ Scan schedule day___ Week___ Standard of
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How to fill out mri request safety

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How to fill out mri request safety form

01
Obtain the MRI request safety form from the hospital or imaging facility.
02
Fill out your personal information such as name, date of birth, and contact information.
03
Provide information about your medical history, any allergies, and current medications you are taking.
04
Indicate any metal implants or devices in your body that may interfere with the MRI scan.
05
Sign and date the form to confirm that all information provided is accurate.
06
Return the completed form to the healthcare provider or imaging facility before your scheduled MRI appointment.

Who needs mri request safety form?

01
Anyone who is scheduled to undergo an MRI scan needs to fill out an MRI request safety form.

What is MRI Request & Safety - stricklandscanner org Form?

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The MRI request safety form is a document used to ensure that patients do not have any contraindications or safety concerns that could make an MRI scan unsafe.
The MRI request safety form must be filled out by patients undergoing MRI scans, as well as by medical professionals requesting the MRI.
To fill out the MRI request safety form, patients must provide personal information, medical history, details of any implants or devices, and answer specific safety questions related to MRIs.
The purpose of the MRI request safety form is to identify any potential risks or contraindications to MRI imaging, ensuring patient safety during the procedure.
The form typically requires information such as patient demographics, medical history, details about any pacemakers or metal implants, allergies, and current medications.
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