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IV Contrast (DYE) sCrEEnIng Form UNIVERSITY OF VIRGINIA - virginia

IV Contrast (DYE) sCrEEnIng Form UNIVERSITY OF VIRGINIA - virginia 2026

IV Contrast (DYE) sCrEEnIng Form UNIVERSITY OF VIRGINIA - virginia Preview on Page 1

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4.8 out of 5

141 votes

The document is a Downtime IV Contrast Screening Form used by the University of Virginia Health System for assessing patients prior to administering contrast material for imaging tests. It includes sections for patient information, medical history, and physician verification regarding allergies and contraindications. The form also outlines necessary lab tests, radiologist protocols, and documentation requirements to ensure patient safety during imaging procedures.

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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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Versions	Form popularity	Fillable & printable
2013	4.8 Satisfied (141 Votes)
2008	4.4 Satisfied (56 Votes)

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