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Fax: 403.592.5090 / phone: 403.592.5078 University of Calgary Liver Unit Fax requests to Jenna Tracey (Fibrosis Technician, UCLA) FIBROSIS REQUEST FORM Date of Request: Jan 6, 2012 *please fill in
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How to fill out fibroscan request form
How to fill out a fibroscan request form:
01
Start by entering your personal information, such as your name, date of birth, and contact details. This information is essential for proper identification and communication regarding your test results.
02
Fill in the required medical information, including your current medications, allergies, and any relevant medical conditions. It is important to provide accurate and detailed information to assist the healthcare professional in interpreting your fibroscan results accurately.
03
Indicate the reason for your fibroscan request. Whether it is for monitoring the progression of a liver disease or assessing the liver's condition, clearly state your purpose for taking this test.
04
Specify any additional tests or procedures you may have undergone related to your liver health. This includes previous fibroscan tests, liver biopsies, or any other relevant examinations. These details can provide valuable context for the healthcare professional interpreting your results.
05
If you have any specific concerns or questions about the fibroscan procedure, make sure to include them in the designated section of the form. This allows the healthcare provider to address any doubts or uncertainties you may have.
06
Review the completed form to ensure that all the information provided is accurate and complete. Any missing or incorrect information can potentially affect the accuracy and interpretation of the fibroscan results.
Who needs a fibroscan request form?
01
Individuals who have been diagnosed with liver diseases such as hepatitis B, hepatitis C, or fatty liver disease may require a fibroscan request form. This non-invasive test provides valuable information about the liver's health and can aid in assessing disease progression or treatment efficacy.
02
Patients who are on long-term medications that can potentially affect liver function, such as certain antibiotics or antiviral medications, may need to undergo periodic fibroscan screenings. These tests help monitor and detect any adverse effects on the liver.
03
People with a history of alcohol abuse or excessive alcohol consumption may benefit from fibroscan screenings to evaluate the extent of liver damage caused by alcohol-related liver disease.
04
Fibroscan request forms may also be necessary for individuals participating in medical research studies or clinical trials focusing on liver diseases. The test results can provide valuable data to researchers and aid in the development of new treatment options.
05
As fibroscan is a non-invasive alternative to liver biopsies, individuals who require routine monitoring of liver health may opt for this test. It is a convenient and painless way to assess liver fibrosis without the need for an invasive procedure.
Overall, the fibroscan request form is relevant for individuals with various liver conditions, those on specific medications or participating in medical research, and individuals seeking routine liver health assessments. It is a crucial step in obtaining accurate and timely information about the liver's condition.
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What is fibroscan request form?
The fibroscan request form is a document used to request a fibroscan procedure for evaluating liver fibrosis.
Who is required to file fibroscan request form?
Patients who need to undergo a fibroscan procedure are required to file the fibroscan request form.
How to fill out fibroscan request form?
To fill out the fibroscan request form, one must provide personal information, medical history, and sign consent for the procedure.
What is the purpose of fibroscan request form?
The purpose of the fibroscan request form is to request and authorize the fibroscan procedure for liver fibrosis evaluation.
What information must be reported on fibroscan request form?
The fibroscan request form must include personal details, medical history, reason for the procedure, and consent for the procedure.
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