MRI Safety Form - Is it safe to scan this person??

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Use this form to record information about implants regarding whether it is safe to scan someone. Please conduct a preliminary review before submitting this form.

Please do not include any Personal Health Information (PHI) or identifying information (e.g., subject names, etc). Any documentation you have should be stored on the Georgetown Box Account assigned to your lab. You will be able to link the box folder with participant information at the end of the first page of this form.

There are some implants that do NOT need to go through this approval process. For the most up to date list of these implants, please see our Implant Approval Guide for Users.

The email address below will be used for correspondence with AUs. This email address will also receive a copy of the form responses upon submission.

Email *

Your Name *

Principle Investigator (PI) *

Subject ID (required) *

Potential Date of Scan (leave blank if not set)

YYYY

Link to Box Folder with Documents about each implant (if any). Please share this folder with: cfmi@georgetown.edu *

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