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IV Contrast (DYE) sCrEEnIng Form UNIVERSITY OF VIRGINIA - virginia 2026
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- Click ‘Get Form’ to open the IV Contrast (DYE) Screening Form in the editor.
- Begin by entering the patient's name and medical record number in the designated area. If a label is not available, write this information clearly.
- Indicate any reasons for contrast screening deferral by checking the appropriate box. Provide additional details if necessary.
- Fill out the physician's verification section, ensuring that allergies and contraindications are confirmed. Include the name of the verifying technologist or radiologist.
- Complete patient-specific questions regarding dialysis, previous contrast experiences, and any relevant medical history. Ensure all responses are accurate.
- Review lab values for BUN and Creatinine, and document them as required. If labs are unavailable, note that an order has been placed.
- Finalize by having the radiologist complete their section, including protocol changes if applicable. Ensure all signatures are obtained before submission.
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Related links
Your doctor has ordered an imaging exam with contrast dye. Now what? Click to learn what contrast does, how its given and what the risks and benefits are.
CESM is a mammogram performed after the injection of IV contrast. CESM is used most often when additional information is needed after a standard mammogram.
ITRC produces documents and training that broaden and deepen technical knowledge and expedite quality regulatory decision making while protecting human health