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Nuclear Medicine Patient Questionnaire Nuclear Medicine Patient Questionnaire

Nuclear Medicine Patient Questionnaire Nuclear Medicine Patient Questionnaire 2026

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The document is a patient questionnaire used for nuclear medicine exams, collecting essential information such as patient demographics, medical history, current medications, allergies, and symptoms. It aims to ensure patient safety by gathering comprehensive health details prior to administering any medications or contrast for the exam.

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Click ‘Get Form’ to open the Nuclear Medicine Patient Questionnaire in the editor.
Begin by entering your Patient Name, Date of Birth, Height, and Weight in the designated fields. This information is crucial for your medical records.
In the 'Exam ordered' section, specify the type of exam you are scheduled for and include the date of the appointment.
Provide detailed information about your Patient History/Symptoms. Use the space provided to list any relevant medical history or current symptoms.
Indicate any Allergies you may have and note when you last ate or drank before your exam.
Fill out the Recent Diagnostic Scans section by specifying types and dates of previous scans like CT, X-ray, MRI, etc.
Complete the Current Medication List by detailing all medications you are taking, including over-the-counter drugs and supplements. If you do not take any medications, check the appropriate box and sign at the bottom.
Finally, review all entered information for accuracy before signing at the bottom of the form. Ensure that a staff member reviews it as well.

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What happens at a nuclear medicine appointment?

It involves having a chemical put into your body that can be picked up by a scanner, similar to having a contrast dye for a CT or MRI scan. But in this case, the chemical known as a tracer or radionuclide is radioactive. The tracer gives off a type of radioactivity called gamma rays.

How do I prepare for a nuclear medicine test?

Prep can vary but may include: No amiodarone for 3 to 6 months before your scan. No IV contrast dye for 12 weeks before your scan. No multivitamins for 2 weeks before your scan. No thyroid medicine for 3 days to 4 weeks before your scan, based on the drug you take. No eating or drinking for 4 hours before your scan.

What to expect during a nuclear medicine scan?

Medical staff may ask you to wear a hospital gown, though in some cases you can wear your own clothes. Youll lie on a table or sit on a chair for the scan. Technicians use a special camera, or scanner, on the appropriate parts of your body to detect gamma rays from the tracer.

How long does a nuclear medicine test take?

A nuclear scan usually takes about 30 to 60 minutes, plus the waiting time after the radioactive material is given. For bone scans, the material takes 2 to 3 hours to be absorbed.

Why would a doctor order a nuclear test?

Your provider may order this test to find out: How well a treatment (medicines, angioplasty, or heart surgery) is working. If you are at high risk for heart disease or complications. If you are planning to start an exercise program or have surgery.

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What is the most common nuclear medicine procedure?

Single Photon Emission Computed Tomography or SPECT and Positron Emission Tomography or PET scans are the two most common imaging modalities in nuclear medicine.

What does a nuclear medicine test consist of?

Nuclear medicine imaging is a method of producing images by detecting radiation from different parts of the body after a radioactive tracer is given to the patient. The images are digitally generated on a computer and transferred to a nuclear medicine physician, who interprets the images to make a diagnosis.