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Patient Information Sheet for Rebateable MRI new docx

Patient Information Sheet for Rebateable MRI new docx 2026

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The document is an Information Sheet and Safety Questionnaire for patients undergoing MRI scans. It collects essential patient details, medical history, and safety information to ensure a safe scanning process. Key areas covered include previous MRI experiences, claustrophobia, mobility assistance needs, surgical history, presence of metal implants or fragments, infectious conditions, and consent for contrast media injection.

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Click ‘Get Form’ to open it in the editor.
Begin by filling in your personal details in the 'Patient Details' section. Enter your surname, date of birth, given names, and approximate weight.
Answer the safety questions regarding previous MRIs, claustrophobia, and mobility assistance. Select 'Yes' or 'No' as applicable.
Provide information about any past surgeries or medical implants. Be thorough in detailing any relevant medical history.
For female patients, indicate if you could be pregnant or are breastfeeding.
Review the consent section regarding contrast media injections and sign at the bottom to confirm that all information is accurate.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (151 Votes)
2016	4.3 Satisfied (63 Votes)

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What do MRI screenings consist of?

MRI is a type of diagnostic test that can create detailed images of nearly every structure and organ inside the body. MRI uses magnets and radio waves to produce images on a computer. MRI does not use ionizing radiation. Images produced by an MRI scan can show organs, bones, muscles and blood vessels.

How to fill MRI form?

The MRI screening form needs to be filled out prior to every new MRI. Each question from the safety form needs to be answered. Responses to yes/no questions, if answered yes, should include further information as requested. Level 2 personnel must check and sign the completed form.

What information should a screening questionnaire for patients about to undergo MRI include?

The MRI Screening Form The form must ask about past surgeries, metallic foreign body injuries, and pregnancy status. The presence of implants, materials, devices, or objects that magnetic fields can damage, including electrically, magnetically, or mechanically activated gadgets, must be elicited.

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