Get the free FibroScan Referral Form - Dartmouth-Hitchcock
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Dartmouth Hitchcock Medical Center One Medical Center Drive Lebanon, NH 037560001 Phone (603) 6505261 Fax (603) 6505225 Dartmouth Hitchcock. Gastroenterology & HEPATOLOGYFibroScan Referral FormReferring
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How to fill out fibroscan referral form
How to fill out fibroscan referral form
01
To fill out a fibroscan referral form, follow these steps:
02
Start by providing your personal information, such as your name, contact details, and date of birth.
03
Next, mention the name and address of the medical facility or clinic where the fibroscan will be conducted.
04
Include the name of the referring doctor or healthcare provider who is recommending the fibroscan test.
05
Specify the reason for the referral, such as suspected liver disease or monitoring of liver fibrosis progression.
06
If applicable, provide any additional medical history or relevant information that may be important for the fibroscan technician to know.
07
Make sure to sign and date the referral form before submitting it to the appropriate department or clinic.
08
Keep a copy of the completed referral form for your records.
09
Please note that the specific layout and required information on the fibroscan referral form may vary depending on the healthcare facility or country.
Who needs fibroscan referral form?
01
The fibroscan referral form is typically needed by individuals who require a fibroscan test to assess the condition of their liver.
02
This may include patients who have been diagnosed with liver disease, individuals at risk of developing liver disease (such as hepatitis C patients), or those who need ongoing monitoring of liver fibrosis progression.
03
In most cases, the referral form is initiated by a doctor or healthcare provider who believes that a fibroscan test is necessary for the patient.
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What is fibroscan referral form?
The fibroscan referral form is a document used to refer patients for a fibroscan procedure, which is a non-invasive way to assess liver health.
Who is required to file fibroscan referral form?
Healthcare providers such as doctors, specialists, or nurses are required to file the fibroscan referral form.
How to fill out fibroscan referral form?
To fill out the fibroscan referral form, healthcare providers need to provide patient information, reason for referral, and any relevant medical history.
What is the purpose of fibroscan referral form?
The purpose of the fibroscan referral form is to document and communicate the need for a fibroscan procedure for a patient.
What information must be reported on fibroscan referral form?
The fibroscan referral form must include patient demographics, clinical history, relevant labs, and reason for referral.
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