Mri questionnaire 2025

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  1. Click ‘Get Form’ to open the MRI questionnaire in the editor.
  2. Begin by entering your MRN and Patient Name at the top of the form. This information is essential for identification.
  3. Fill in your Sex, Age, Height, and Weight. Accurate details help ensure a safe MRI experience.
  4. For each item listed under 'MRI Safety Screening', provide a 'yes' or 'no' answer. Be honest about any medical devices or conditions that may affect your scan.
  5. If you are a female patient, answer the additional questions regarding pregnancy and breastfeeding. This information is crucial for safety during the procedure.
  6. Review all your answers carefully before signing at the bottom of the form to attest that the information provided is correct.
  7. Once completed, save your document and share it with your healthcare provider directly through our platform for seamless processing.

Start filling out your MRI questionnaire today for free and ensure a smooth scanning process!

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you think you have any metal in or on your body. youre pregnant or breastfeeding. youve ever had an allergic reaction to a contrast agent. you have kidney problems.
You will typically be asked to change into a gown and to remove things that might affect the magnetic imaging, such as: Jewelry. Hairpins. Eyeglasses. Watches. Wigs. Dentures. Hearing aids. Underwire bras.
Youll be asked if youre pregnant or have any medical conditions. Youll also be asked if you have any metal or electronic implants because these may cause problems during your MRI scan. Your radiographer will go through a checklist of metal items that you may have inside your body.
The form requests information regarding a prior surgical procedure to help determine if there may be an implant or device present that could create a problem. Information is also requested pertaining to prior diagnostic imaging studies that may be helpful to review for assessment of the patients condition.
Fillings, bridges, and other dental work typically do not pose a problem. But other metal that has been put into your body might prevent you from having an MRI. That includes some pacemakers, clips for treating aneurysms, and other devices with metal in them. A nurse may review your health history before your exam.

People also ask

Lack of Medical Necessity: Insurers often require evidence that the MRI is medically necessary. If the physicians documentation does not sufficiently support the need for the MRI based on the patients condition, the claim may be denied.
Artificial joints, limbs, or heart valves. Body piercings. Cochlear implants (which help with hearing) Metal fragments, bullets, or shrapnel anywhere in your body.

mri safety questionnaire