MRI Patient Checklist and Consent

  • MRI patient Checklist & Consent

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  • The following may be hazardous or may interfere with the examination by producing an artifact

  • Please remove all jewlery (except wedding band), bobby pins, watches, cell phone, credit cards, hearing aids.

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    If so please notify the technologist/nurse if you do not have a ride home, or you are unable to drive home safely and we will arrange transport

  • *If you experience a heat sensation or tugging, please notify the technologist

  • Consent to the Use of Gadolinium

  • Introduction: As part of your examination, your physician has deemed it advisable to give you an I.V. injection of contrast agent containing GADOLINIUM. This injection may help the physician more accurately diagnose your condition.

    Possible Reactions: All medical procedures carry an element of risk and this procedure is no exception. It is our intention to describe these risks and then request your signature indicating your understanding of this information.

    Although, Gadolinium contrast agents have been used safely in millions of cases, minor reactions (principally headache or nausea) occur in about 2% of patients, whereas serious or life threatening reactions have been reported in about 1 in 400,000 patients.

    Please drink 16 ounces of water over a 2 hour period after the contrast injection

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