Epstein Secrets

e provide date of implant: O Magnetic Dental Implants O Transdermal Patches 0 IUD O Tissue expander for future implants O Bone Stimulators. Insulin Pumps. or Mechanical Valves O Programmable Shunts WARNING: fore entering the MR room, you must remove all metallic objects including HEARING AIDS, DEN

scopy within the last 6 weeks? If yes. date of exam YES NO DO YOU HAVE ANY OF THE FOLLOWING IN YOUR BODY? 0 Brain/Aneurysm Clips 0 Pacemaker, Pacer Wires or Defibrillator if yes. make% year O Any Metallic fragment or foreign body O Ear Implants or Hearing Aids O Electrical Stimulators O Implant/Prosthesis O

s If yes, please provide date of implant Magnetic Dental Implants Transdermal Patches IUD Tissue expander for future implants Bone Stimulators. Insulin Pumps, or Mechanical Valves Programmable Shunts WARNING: Before entering the MR room, you must remove all metallic objects Including HEARING AIDS, DENTU

ed? If yes, when? Any surgery on your eyes, ears brain or heart? DO YOU HAVE ANY OF THE FOLLOWING IN YOUR BODY? Brain/Aneurysm Clips Pacemaker, Pacer Wires or Defibrillator if yes, make\ year Ear Implants or Hearing Aids Electrical Stimulators Implant/Prosthesis Infusion Pumps Coils. Catheters. Fitters or Wires in

implant: 0 Q Magnetic Dental Implants I= D Transdermal Patches CI D IUD 0 0 Tissue expander for future implants 0 0 Bone Stimulators. Insulin Pumps, or Mechanical Valves 0 D Programmable Shunts WARNING: Before entering the MR room, you must remove all metallic objects including HEARING AIDS,

within the last 6 weeks? If yes, date of exam YES NO DO YOU HAVE ANY OF THE FOLLOWING IN YOUR BODY? 0 0 Brain/Aneurysm Clips 0 0 Pacemaker, Pacer Wires or Defibrillator if yes, make\ year 0 0 Any Metallic fragment or foreign body CI O Ear Implants or Hearing Aids 0 C7 Electrical Stimulators 0 0 Implant/Pr