[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-403470-105":59,"doc-detail-403470-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","ara-mri-prostate-order-form-mri-prostate-order-form","ARA-MRI-Prostate-Order-Form - MRI Prostate Order Form","","MRI Prostate Order Form for ordering prostate MRI imaging, including options with perfusion with and without contrast, post-prostatectomy imaging with and without contrast, and radiation treatment planning without contrast. The form captures patient information, diagnosis, PSA value, referring/ordering physician, scheduling and contact details for ARA clinics, and appointment date/time/arrival fields. It also provides preparation instructions such as fasting timelines, bowel preparation steps, enema use, metal/jewelry precautions, and guidance for implant device identification, plus a revised date of 10/19/21.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/ara-mri-prostate-order-form-mri-prostate-order-form/403470/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/ara-mri-prostate-order-form-mri-prostate-order-form/403470.png","ImageObject",300,407,{"name":92,"@type":93},"Jacob","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-27",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What MRI prostate imaging options can be ordered on this form?","Question",{"text":113,"@type":114},"The form lists MRI Prostate with perfusion with and without contrast, MRI Prostate post prostatectomy with and without contrast, and MRI Prostate radiation treatment planning without contrast (without contrast).","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What preparation steps are required before the MRI?",{"text":118,"@type":114},"Preparation includes arriving 30 minutes early, leaving jewelry/metal at home, and following bowel prep and fasting guidance: Dulcolax tablets 12–16 hours prior, a limited last meal at least 8 hours prior with no dairy, clear liquids only 8 hours prior, and a saline Fleet enema 1 hour prior to leaving home/arriving at the clinic.",{"name":120,"@type":111,"acceptedAnswer":121},"Does the form mention special requirements related to implants or infusion history?",{"text":122,"@type":114},"Yes. It requests bringing identification for implant devices and notes a required two-week waiting period after iron infusion, and it recommends morning appointments.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},403470,1790619088,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":8,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":81,"preview_page_count":4},962084931830,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","MRI PROSTATE ORDER FORM  \nPatient name:   Phone:   Diagnosis:   PSA (prostate-specific antigen) value:    \nMRI Prostate with perfusion with and without contrast (72197—MRI Pelvis with and without contrast)  \nMRI Prostate post prostatectomy with and without contrast (72197—MRI Pelvis with and without contrast)  \nMRI Prostate radiation treatment planning without contrast (72195—MRI Pelvis without contrast)  \nProvider scheduling line: (512) 458-9098 | Scheduling fax: (512) 836-8869  \nAppointment date: _____________________ Appointment time: ____________ Arrival time: _____________  \nOrdering physician: ___________________________________________________________________________  \nSignature: __________________________________________________________ Date: __________________  \nAppointment locations:  \nARA Austin Center Boulevard-6818 Austin Center Blvd. , \\#101, Austin, TX 78731  \nARA Cedar Park-12800 W. Parmer Ln, \\#200, Cedar Park, TX 78613  \nARA Kyle-4211 Benner Rd. , \\#100, Kyle, TX 78640  \nARA Medical Park Tower-1301 W. 38th St. , \\#118, Austin, TX 78705  \nARA Manor-12700 Lexington St. , \\#300, Manor, TX 78653  \nARA Southwood-1701 W Ben White Blvd. , \\#170, Austin, TX 78704  \nARA Wilson Parke-11714 Wilson Parke Ave. , \\#175, Austin, TX 78726  \nPrep instructions for MRI Prostate with perfusion and MRI Prostate post prostatectomy:  \n*Does not apply to prostate radiation treatment planning (72195).  \nArrive 30 minutes prior to exam. Please leave all jewelry and metal objects at home. If applicable, bring an identification card for any implant devices in the body, or any hand held or remote programmer device. Requires a two-week waiting period post iron infusion. Morning appointments preferred.  \n• 12 to 16 hours prior-take 2 Dulcolax tablets.  \n• Limit last meal (at least 8 hours prior) to a small sandwich, Jell-O, soup, or broth. No dairy products.  \n• 8 hours prior-nothing to eat or drink except clear liquids.  \n• 1 hour prior to leaving home/arriving at the clinic-perform a saline Fleet enema.  \nRevised 10/19/21","cbCaitC4hDIUhqlp","https://ap.wps.com/l/cbCaitC4hDIUhqlp","pdf",1011767,"English","# MRI Prostate Order Form\n## Imaging options and CPT references\n## Provider scheduling and appointment details\n## Ordering physician and signature\n## Appointment locations\n## Pre-exam preparation instructions","[{\"question\":\"What MRI prostate imaging options can be ordered on this form?\",\"answer\":\"The form lists MRI Prostate with perfusion with and without contrast, MRI Prostate post prostatectomy with and without contrast, and MRI Prostate radiation treatment planning without contrast (without contrast).\"},{\"question\":\"What preparation steps are required before the MRI?\",\"answer\":\"Preparation includes arriving 30 minutes early, leaving jewelry/metal at home, and following bowel prep and fasting guidance: Dulcolax tablets 12–16 hours prior, a limited last meal at least 8 hours prior with no dairy, clear liquids only 8 hours prior, and a saline Fleet enema 1 hour prior to leaving home/arriving at the clinic.\"},{\"question\":\"Does the form mention special requirements related to implants or infusion history?\",\"answer\":\"Yes. It requests bringing identification for implant devices and notes a required two-week waiting period after iron infusion, and it recommends morning appointments.\"}]","ARA-MRI-Prostate-Order-Form - MRI Prostate Order Form | PDF",1790540660]