Run Radiology Pause and Verify — Free

Patient Identification

Patient identity confirmed using two identifiers critical (required)

Confirm the patient using two approved identifiers such as full name and date of birth.

Yes No N/A

Order matches patient and scheduled exam critical (required)

Verify the imaging order is for the correct patient and the intended study.

Yes No N/A

Patient armband and chart information match critical (required)

Ensure wristband, requisition, and chart information are consistent.

Yes No N/A

Procedure and Laterality Verification

Procedure name verified with patient and order critical (required)

Confirm the planned radiology procedure is correct and understood by the team.

Yes No N/A

Laterality confirmed when applicable critical (required)

Verify left/right side, if applicable, matches the order and consent.

Yes No N/A

Correct body part and site marked or identified critical (required)

Confirm the correct anatomic site for the exam or intervention.

Yes No N/A

Contrast Safety Review

Contrast required for this exam

Confirm whether contrast is part of the planned study.

Yes No N/A

Contrast allergy history reviewed critical (required)

Check for prior contrast reactions or relevant allergies.

Yes No N/A

Premedication or mitigation plan verified if needed critical (required)

Confirm any required premedication, alternative agent, or physician approval is documented.

Yes No N/A

IV access and contrast administration readiness confirmed

Verify IV patency, access type, and readiness for contrast administration.

Yes No N/A

Pregnancy and Safety Screening

Pregnancy status screened when applicable critical (required)

Confirm pregnancy screening was completed according to policy for patients of childbearing potential.

Yes No N/A

Pregnancy test result reviewed if required critical (required)

Verify a valid pregnancy test result is available when indicated.

Yes No N/A

Additional safety concerns addressed

Document any other relevant safety concerns, such as implants, mobility limitations, or sedation needs.

Yes No N/A

Time-Out Completion

Team pause and verbal time-out completed critical (required)

Confirm the team verbally paused to review the patient, procedure, laterality, and contrast plan.

Yes No N/A

All concerns resolved before proceeding critical (required)

Verify any discrepancies or concerns were addressed before the exam started.

Yes No N/A

Inspector signature critical (required)

Signature of the person completing the verification.

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Run: Radiology Pause and Verify

Patient Identification

Procedure and Laterality Verification

Contrast Safety Review

Pregnancy and Safety Screening

Time-Out Completion

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