Get the free FibroScan Referral Form - polyclinic

FIBROSIS PROGRAM Dr. Mandy Elkhashab, M.D., M.Sc., FRC×C) Gastroenterology and Liver Disease 2 Champagne Drive (Champagne Center×, Unit B17 Tel: 416 2226160 ext 277 Fax: 416 6451978 FIBROSIS REFERRAL

How to fill out fibroscan referral form

How to fill out a fibroscan referral form:

1. First, ensure that you have all the necessary information and forms required for the referral. This typically includes the patient's personal details, medical history, and relevant lab test results.
2. Begin by filling out the basic information section of the referral form. This may include the patient's name, date of birth, contact information, and current address.
3. Next, provide details about the referring healthcare professional. This includes their name, clinic or hospital name, contact information, and any special credentials or affiliations.
4. Proceed to fill out the medical history section of the referral form. This may require providing information such as the patient's previous diagnoses, current medications, allergies, and any other relevant medical conditions.
5. If the fibroscan referral form requires specific lab test results, make sure to attach the necessary documents or provide the relevant details in the corresponding section.
6. It is important to mention any additional information or specific concerns regarding the patient's condition that may be helpful for the receiving healthcare professional to know.
7. Review the completed referral form thoroughly to ensure accuracy and completeness of information.
8. Once you are satisfied with the filled-out form, submit it following the designated procedure specified by the healthcare facility or provider.
9. Keep a copy of the completed referral form for your records, as it may be needed for future reference.

Who needs a fibroscan referral form:

1. Patients who require further evaluation of liver health or liver-related conditions may need a fibroscan referral form. This non-invasive procedure assesses the amount of liver fibrosis present, aiding in the diagnosis and management of liver diseases.
2. Healthcare professionals who suspect liver-related disorders in their patients, such as Hepatitis B or C, fatty liver disease, or cirrhosis, may require a fibroscan referral to accurately evaluate the severity of liver damage and plan appropriate treatment.
3. Individuals with a family history of liver disease or those who display symptoms such as fatigue, unexplained weight loss, abdominal pain, or jaundice may also benefit from a fibroscan referral to assess their liver health.

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What is fibroscan referral form?

Fibroscan referral form is a document used to refer a patient for a fibroscan liver test.

Who is required to file fibroscan referral form?

Healthcare providers, doctors, or specialists are required to file the fibroscan referral form for their patients.

How to fill out fibroscan referral form?

The fibroscan referral form can be filled out by providing patient information, medical history, reason for referral, and any other relevant details.

What is the purpose of fibroscan referral form?

The purpose of the fibroscan referral form is to facilitate the process of scheduling and conducting a fibroscan liver test for a patient.

What information must be reported on fibroscan referral form?

The fibroscan referral form must include patient name, contact information, medical history, reason for referral, referring healthcare provider, and any relevant medical notes.