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You can mail the completed form to The Orthopaedic & Fracture Clinic, or fax it to (507) 386-1831 (attention – FMH Support), bring the form to your next appointment, or drop it off at OFC.

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Mankato Regional Imaging
DSC01078What is MRI?

Magnetic Resonance Imaging is a method of obtaining detailed pictures of internal body structures without the use of radiation or radioactive substances of any kind. This is accomplished by placing the patient in a magnetic field while harmless radio waves are turned on and off. This causes the body to emit its own weak radio signals which vary according to tissue characteristics. These signals are then picked up by a sensitive antenna and fed to a computer which produces detailed images of the body for interpretation by trained radiologists.

Patient Safety

MRI is a convenient and safe diagnostic procedure for most patients, however, contra-indications do exist. Please note that a patient may not qualify for a MRI exam if any of the following conditions exist:


Cardiac Pacemaker
Aneurysm Clips
Electromechanical Aids
Cochlear Aids
Tens Unit
Inferior Vena Cava Umbrellas
Implanted Drug Infusion Devices
Intraocular Foreign Objects
Bullet or Shrapnel Wounds

Please alert us to any of the above conditions when you schedule an appointment and inform the technologist of your condition before beginning an examination.

MRI Forms (Referring Clinic)

Prior to scheduling an MRI with The Orthopaedic & Fracture Clinic, please complete the attached Patient History & Safety Questionnaire in its entirety. This form will help the MRI scheduling department determine which MRI scanner is the best fit for your patient.

The attached MRI Outpatient Order Form will need to be completed by a medical provider.

After the MRI has been scheduled with the MRI scheduling department, please fax the completed forms to OFC at (507) 388-1457.

Please make sure to fill out the forms completely, as all of the information is needed in preparation for the patient’s appointment.


MRI Outpatient Order Form

OFC Authorization to Discuss or Release Information


There is no special preparation for an MRI exam. You can eat normally and continue to take prescribed medications as required. If possible, wear loose, comfortable clothing, free of zippers, buttons, or other metallic devices. You will need to remove all metal objects that you may be carrying including: watches, eyeglasses, keys, pens, coins, hairpins, jewelry, dentures and hearing aids.

Since the magnet will erase information on bank cards and credit cards, these should be stored in the locked dressing room that will be provided for your personal belongings. You may be asked to change into a robe.


You will be instructed to lie comfortably on the scanning table and a special coil will be attached to the area of your body being examined. You can then relax while the scanner and the technologist do the work.

The technologist will direct the scan from the computer console or “command center” of the system and will talk to you through a speaker while the images are being produced and viewed on a monitor.

You can help to produce a high quality image by lying still during the examination, while breathing normally. You can arrange with the technologist to have a close friend or family member sit with you throughout the exam. An average scan will take from 30-60 minutes to complete.

After Your Exam

Your scan will be reviewed and interpreted by one of the following Radiologists at the Mankato Clinic, Ltd. A separate billing will be sent to you for this interpretation.

James R. Custer, M.D., Sarah Clauss, M.D., Lynn Hassan, M.D.

Important Reminders

Do not bring any metal objects into the examination room. Please use the restroom as you will not be able to do so once the scan has started.


MRI Locations

Siemens 3.0 MRI – Mankato, MN
Open Sided MRI
Healthcare Campus Imaging One MRI