Breadcrumb Home Other Checklists MRI Technician Form Information Info Name * Last 4 digits of SSN * Contact Phone * Email * Proficiency Scale 1 = No Experience 2 = Need Training 3 = Able to perform with supervision 4 = Able to perform independently Work Settings Adult Acute Care * Adult Outpatient * Pediatric Acute Care * Pediatric Outpatient * Procedures Angio Studies * Abdominal Aorta * Abdomen * Chest * Circle of Willis * Head without Contrast * Lower Extremities * Neck * Pelvis * Renal * Subclavian * Venogram Studies * Carotid/Neck * Renals * Upper Extremities * MR Studies * Head/Neck * Brain/Head w/wo Contrast * Face w/wo Contrast * Internal Auditory Canal w/wo Contrast * Mandible w/wo Contrast * Nasopharynx without Contrast * Orbits w/wo Contrast * Pituitary w/wo Contrast * Soft Tissue Neck w/wo Contrast * Sinuses w/wo Contrast * TMJ w/wo Contrast * Abdomen/Pelvis * Abdomen w/wo Contrast * Adrenals w/wo Contrast * Buttock w/wo Contrast * Cholangiogram * Pelvis w/wo Contrast * Prostate w/wo Contrast * Renal w/wo Contrast * Scrotum with Contrast * Brachial Plexus * Breast w/wo Contrast * Chest w/wo Contrast * Myocardium w/wo Contrast * Sternum w/wo Contrast * Spine * Cervical Spine w/wo Contrast * Thoracic Spine w/wo Contrast * Lumbar Spine w/wo Contrast * Sacrum w/wo Contrast * Shoulder w/wo Contrast * Arthrogram Shoulder * Elbow w/wo Contrast * Wrist w/wo Contrast * Hand/Finger w/wo Contrast * Hip w/wo Contrast * Knee without Contrast * Ankle w/wo Contrast * Foot w/wo Contrast * MRI Scan Types Gradient Echo Imaging * Multiplanar Reconstruction/MRA * Spin Echo Images * Surface Coils * Extremity * Head * Neurovascular * Shoulder * Spine/Phase Array * Torso * T-1 Weighted Images * Equipment Phillips * Siemens * Toshiba * Hitachi * General Electric * Other * Age Specific Experience Newborn/Neonate (birth to 30 days) * Infant (1 month to 1 year) * Toddler (1 year to 3 years) * Preschooler (3 years to 5 years) * School Age Child (5 years to 12 years) * Adolescents (12 years to 18 years) * Young Adults (18 years to 39 years) * Middle Adults (39 to 64 years) * Geriatric Adults (65+ years) * EMR Allscripts * Aria * Athena * Canopy * Cerner * Epic * Eclipsys * Mckesson * Meditech * Other Computerized System *