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Memorial hermann screening form 2025

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The document is a screening form for patients undergoing Magnetic Resonance (MR) procedures, emphasizing the importance of disclosing any implants, devices, or objects that may pose hazards during the MRI process. It instructs patients to consult with MRI Technologists or Radiologists regarding any concerns before entering the MR environment and outlines necessary precautions, including the removal of all metallic objects. The form also includes sections for patient acknowledgment and signatures.

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Click ‘Get Form’ to open the memorial hermann screening form in the editor.
Begin by reviewing the important instructions regarding metallic objects and implants. This section is crucial for your safety during the MRI procedure.
Indicate any relevant medical history by checking 'Yes' or 'No' for each item listed, such as claustrophobia or any implants. Be thorough to ensure accurate assessment.
Use the provided figures to mark the location of any implants or metal inside or on your body. This visual aid helps technicians understand your situation better.
Complete the attestation section at the end of the form, confirming that all information is correct. Sign and date where indicated.
If applicable, have a relative or nurse complete their section, ensuring all signatures are collected before submission.

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2009	4.8 Satisfied (46 Votes)

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