BMC Patient Intake Questionnaire

What is it?

The Bone Density Patient Intake Questionnaire is a form that every patient fills out prior to having a bone density scan. Other names for this form are: Bone Health History Form, Patient Bone Density History Form. It is important to fill out this form prior to every bone density scan.

The purpose of this form is to provide background information which will assist the technologist in acquiring the scan and help the Clinician who interprets the results of the scan.

How should the Bone Density Patient Intake Questionnaire be used and who should use it?

The bone densitometry technologist will use this form to help in the acquisition and analysis of the scan, and to explain any artifacts (foreign objects) that may appear in the scan region. For example, has the patient had another radiologic exam within the past week that involves contrast material? Contrast material (dye) from other radiographic tests (barium, renal, CT, MRI studies) could obstruct the regions of interest that we look at when performing a DXA scan. Other examples of information the technologist needs to know about is surgical implants due to surgery (like metal rods in the spine and hip joint replacements), current medications, fracture history, height, weight, etc.

The clinician/interpreter will use this form to assess factors that affect your results and other indications that suggest a diagnosis. For example: Have you had a loss in height or weight? What medications are you taking and how do they affect your bone metabolism? Have you had a previous fracture?

Providing an updated and accurate Bone Density Patient Intake Questionnaire prior to every scan is the first step to obtaining accurate and precise Bone density scan results.

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Last modified: December 30, 2012