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FIBROSIS PROGRAM REFERRAL FORM Dr. Mandy Elkhashab, M.D., M.Sc., FRC© Gastroenterology and Liver Disease 1664 Duffer in St., Toronto, Ont., M6H 3M1 Tel: 4166529662 /Fax: (416) 6525367 10 Controlled

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How to fill out online fibroscan program fax

01

Visit the official website of the online FibroScan program.

02

Locate the 'Fax Application' section on the website.

03

Download the FibroScan program fax form.

04

Fill out your personal information including name, date of birth, and contact details.

05

Provide any relevant medical history related to liver health.

06

Select the FibroScan test options as per your physician's recommendation.

07

Include your physician's contact information and any required signatures.

08

Review the form for completeness and accuracy.

09

Print the completed form or save it as a PDF.

10

Fax the completed form to the designated FibroScan program fax number provided on the website.

Who needs online fibroscan program fax?

01

Individuals with liver disease or at risk of liver disease.

02

Patients under the care of a healthcare provider who recommends a FibroScan test.

03

People who require liver health monitoring or assessment.

04

Clinics and healthcare facilities that provide liver health screenings.

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What is online fibroscan program fax?

The online fibroscan program fax is a digital platform used for submitting fibroscan program-related documents electronically via fax.

Who is required to file online fibroscan program fax?

Healthcare providers and facilities that perform fibroscan procedures are required to file the online fibroscan program fax.

How to fill out online fibroscan program fax?

To fill out the online fibroscan program fax, users need to access the designated web portal, enter the required patient and procedure information, and submit the form electronically.

What is the purpose of online fibroscan program fax?

The purpose of the online fibroscan program fax is to streamline the reporting process for fibroscan procedures, ensuring accurate and timely data submission.

What information must be reported on online fibroscan program fax?

The information required includes patient identification, procedure details, provider information, and results of the fibroscan test.

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