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Mri screening form 2025

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The document is an MRI Patient Assessment, Screening and Order Form used by the Radiology Department. It includes sections for patient information, clinical indications for the exam, and a detailed screening questionnaire to identify any contraindications or relevant medical history that may affect the MRI procedure. The form emphasizes the importance of disclosing previous surgeries and medical conditions, particularly those related to implants or devices that could interfere with the MRI.

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Versions	Form popularity	Fillable & printable
2013	4.8 Satisfied (216 Votes)

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What is an MRI screening form?

Patients are normally screened for contraindications to MRI using a hospital-approved screening form prior to entering the scanner suite. This form is completed by the patient or by his or her healthcare provider, and reviewed by the scanning technologist prior to the patients MRI examination.

What is an MRI screening?

Screening means taking pictures of various parts of your body to detect cancer or other serious problems early on before symptoms appear. Diagnostic imaging, which includes x-rays and MRI scans, is used to determine what caused a specific problem with a persons health.

Who can fill out a patients MRI screening form?

If patient is unable to provide the history to complete the screening form, a family member or a guardian can complete the questionnaire. The Level 2 personnel should go through available patient records including surgical history, implant history and review of prior imaging in the system if present.

How to find MRI screening form on Epic?

Inpatient: MRI Screening Form The link to the electronic MRI screening form is in the Orders Requiring A Screening Form section of the Order Report or on the Rad Patent List report.

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