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Responses > Safety Screening Forms prior to Imaging Examination

Freedom of Information request Safety Screening Forms prior to Imaging Examination

Response published: 15 August 2025
Misc

FOI Request

We would ask for your NHS Trust to provide information on two aspects: 1. Whether safety screening forms or checklists which are completed by patients prior to a diagnostic imaging examination are in paper form or in digital format (e.g. web-based or tablet)? This includes but may not be limited to: • Inclusive Pregnancy status (IPS) or last menstrual period (LMP) forms • Magnetic resonance imaging (MRI) safety forms • Contrast media administration (all modalities) • Bone densitometry (DXA) patient questionnaire • Any other examination-specific forms e.g. CT colonography or cardiac questionnaires. 2. If any of these are completed in paper form, we would ask for a copy of the current version to be sent via email. We do not require information regarding staff completed forms e.g. WHO safety forms however, we would request that forms initially completed by a patient and co-signed by a staff member at the time of the examination are included. The information is being sought to compare practice across Trusts.

FOI Response

Freedom of Information Request – Ref: FOI 143-2025

Thank you for your recent Freedom of Information request. Please find our response below.

You asked:

We would ask for your NHS Trust to provide information on two aspects:

1. Whether safety screening forms or checklists which are completed by patients prior to a diagnostic imaging examination are in paper form or in digital format (e.g. web-based or tablet)?

This includes but may not be limited to:

  1. Inclusive Pregnancy status (IPS) or last menstrual period (LMP) forms
  2. Magnetic resonance imaging (MRI) safety forms
  3. Contrast media administration (all modalities)
  4. Bone densitometry (DXA) patient questionnaire
  5. Any other examination-specific forms e.g. CT colonography or cardiac questionnaires.

2. If any of these are completed in paper form, we would ask for a copy of the current version to be sent via email.

We do not require information regarding staff completed forms e.g. WHO safety forms however, we would request that forms initially completed by a patient and co-signed by a staff member at the time of the examination are included.

The information is being sought to compare practice across Trusts.

Our response:

The Trust does not provide the service mentioned on your request. Please redirect your request to Gloucestershire Hospitals NHS Foundation Trust, at ghn-tr.foi@nhs.net

Next steps:

Should you have any queries in relation to our response, please do not hesitate to contact us. If you are unhappy with the response you have received in relation to your request and wish to ask us to review our response, you should write to:

Louise Moss
Head of Legal Services / Associate Director of Corporate Governance
c/o Gloucestershire Health and Care NHS Foundation Trust
Edward Jenner Court
1010 Pioneer Avenue
Gloucester Business Park
Brockworth, GL3 4AW
E-mail: louise.moss@ghc.nhs.uk

If you are not content with the outcome of any review, you may apply directly to the Information Commissioner’s Office (ICO) for further advice/guidance. Generally, the ICO will not consider your case unless you have exhausted your enquiries with the Trust which should include considering the use of the Trust’s formal complaints procedure. The ICO can be contacted at: The Information Commissioner’s Office, Wycliffe House, Water Lane, Wilmslow, Cheshire SK9 5AF.