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Click ‘Get Form’ to open the MRI screening form in our editor.
Begin by filling in the 'Referring Clinic' and 'Exam Requested' fields. These are essential for identifying the purpose of the exam.
Next, enter the 'Date/Time of Exam' and 'Referring Physician' details. Accurate information here ensures proper scheduling and communication.
In the 'Clinical Indication for Exam' section, provide a brief description of why the MRI is being requested. This helps radiologists understand your needs.
Fill out patient details such as height and weight. This information is crucial for accurate imaging results.
Carefully answer all questions regarding medical history, allergies, and previous surgeries. Pay special attention to questions marked with asterisks, as they indicate critical contraindications.
Finally, ensure that both you and the interviewer sign and date the form at the bottom before submission.
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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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