Appendix A: Examples of MRI-CS eligibility sheets
This appendix shows examples of MRI conditionally safe (MRI-CS) eligibility sheets
produced by Medtronic clinician programmers that are appropriate for the patient's MRI
appointment.
The MRI-CS eligibility sheet shows the MRI-CS scan-type eligibility for the patient's
implanted neurostimulation system for chronic pain after the patient has seen the clinician
managing the patient's neurostimulation system.
The following are the three types of MRI-CS eligibility sheets:
– MRI-CS Report
– MRI-CS Mode screen printout
– MRI-CS Eligibility Form completed by the patient's physician (see "Appendix B: MRI-
CS Eligibility Form" on page 27)
Examples of MRI-CS reports and screen printouts
See the next page for examples of MRI conditionally safe (MRI-CS) eligibility sheets
produced by Medtronic clinician programmers that are appropriate for the patient's MRI
appointment.
24 English MRI guidelines for Medtronic neurostimulation systems for chronic pain