Interventional Radiology Procedure Intake Form

Streamline Your Interventional Radiology Intake with Paperform

Interventional radiology procedures require meticulous pre-procedure assessment to ensure patient safety and optimal outcomes. This Interventional Radiology Procedure Intake Form template helps radiology departments, imaging centers, and hospitals collect critical patient information efficiently before procedures.

Why This Template Works for Healthcare Providers

This form captures everything your IR team needs in one place: comprehensive medical history, current medications with specific focus on anticoagulation therapy, contrast allergy history, prior imaging review, and procedural risk acknowledgment. Instead of juggling paper forms, phone calls, and fragmented records, you can collect standardized, complete information that flows directly into your workflow.

Key features for interventional radiology practices:

• Anticoagulation screening with detailed medication tracking to identify bleeding risks
• Contrast media allergy assessment with severity classification and prior reaction documentation
• Imaging history review to ensure proper procedural planning
• Procedural consent and risk acknowledgment captured digitally for compliance
• Conditional logic that adapts questions based on patient responses

Automate Your Pre-Procedure Workflow

Once a patient submits this form, Paperform's native integrations and Stepper (stepper.io) can automatically route information where it needs to go. Send high-risk patients flagged for anticoagulation issues directly to your nursing team for phone follow-up, log submissions in your EMR via API webhooks, or trigger appointment confirmation emails based on clearance status.

For facilities managing multiple procedural teams, this template ensures consistency across providers while maintaining the flexibility to customize questions for specific procedure types. With Paperform's Papersign (papersign.com), you can even convert consent acknowledgments into formal eSignature documents that maintain HIPAA-compliant audit trails.

Trusted by healthcare organizations nationwide, this template helps interventional radiology departments reduce pre-procedure phone calls, minimize day-of-procedure cancellations due to incomplete workup, and improve patient safety through standardized screening protocols.

Note: While Paperform is SOC 2 Type II compliant, it is not a HIPAA-compliant solution. Please ensure your organization's use case aligns with appropriate compliance requirements.