Get the free HYDROGEN BREATH TESTING REFERRAL FORM - med monash edu

HYDROGEN BREATH TESTING REFERRAL FORM Eastern Health Clinical School Level 1, 5 Arnold Street, Box Hill Vic 3128 Please perform the following tests: Lactulose ? * Lactulose is the control sugar, and

How to fill out hydrogen breath testing referral

How to Fill Out Hydrogen Breath Testing Referral:

1. Obtain the necessary referral form from your healthcare provider or medical facility.
2. Fill in your personal information accurately, including your full name, date of birth, address, and contact information.
3. Provide your medical history, including any relevant conditions, medications, or allergies that may impact the testing process.
4. Specify the reason for needing a hydrogen breath test, such as suspected lactose intolerance or small intestinal bacterial overgrowth (SIBO). Include any relevant symptoms you may be experiencing.
5. Indicate any prior testing or treatments you have undergone related to the suspected condition. This information will help the healthcare provider assess your case more effectively.
6. If applicable, include the name and contact information of the referring healthcare provider who recommended the hydrogen breath testing.
7. Double-check all the information you have provided to ensure accuracy and completeness.
8. Sign and date the referral form, confirming that you have provided truthful and complete information.
9. Follow any additional instructions provided by your healthcare provider or medical facility regarding the submission of the referral form.

Who Needs Hydrogen Breath Testing Referral:

1. Individuals experiencing gastrointestinal symptoms such as bloating, abdominal pain, diarrhea, or constipation that may be caused by certain gastrointestinal disorders.
2. Individuals suspected of having lactose intolerance or other carbohydrate malabsorption issues.
3. Patients with suspected small intestinal bacterial overgrowth (SIBO) or who have been diagnosed with SIBO in the past.
4. Those who have not responded to other conventional treatments or medications for their gastrointestinal symptoms.
5. People who have a family history of gastrointestinal disorders or conditions that may require hydrogen breath testing for accurate diagnosis.
6. Individuals under the care of a healthcare provider who wants to rule out or confirm certain gastrointestinal conditions through hydrogen breath testing.
7. Patients who exhibit symptoms that may be suggestive of an underlying gastrointestinal disorder but require further diagnostic testing for confirmation.

For pdfFiller’s FAQs

What is hydrogen breath testing referral?

Hydrogen breath testing referral is a medical test used to diagnose conditions such as lactose intolerance and bacterial overgrowth in the small intestine.

Who is required to file hydrogen breath testing referral?

Healthcare providers such as doctors or gastroenterologists are required to file hydrogen breath testing referrals for their patients.

How to fill out hydrogen breath testing referral?

To fill out a hydrogen breath testing referral, the healthcare provider must include the patient's information, reason for referral, relevant medical history, and any other pertinent details.

What is the purpose of hydrogen breath testing referral?

The purpose of hydrogen breath testing referral is to accurately diagnose gastrointestinal conditions by measuring the amount of hydrogen gas in a patient's breath after ingesting specific substances.

What information must be reported on hydrogen breath testing referral?

The hydrogen breath testing referral must include the patient's demographics, symptoms, relevant medical history, and specific instructions for the test.

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