Get the free Urea breath test referral form for GP use (PDF version)

Urea Breath Test Referral Patient Details Surname: Address: Forename: Title(Mr/Ms etc): NHS Number: Postcode: Date of birth: Tel No.: GP/Referrer Details Name: Tel No.: Surgery Address: Date of Request:

How to fill out urea breath test referral

How to fill out urea breath test referral:

1. Obtain the referral form: Start by obtaining the specific urea breath test referral form from the healthcare provider who has recommended or ordered the test. This form may be provided in a physical or electronic format.
2. Provide patient information: Fill out the patient information section accurately. Include the patient's full name, date of birth, contact information, and any other details required. Double-check the information for errors or typos.
3. Mention the reason for the test: In the appropriate section, provide a clear and concise explanation of why the patient needs to undergo the urea breath test. Include any relevant symptoms, medical history, or suspected conditions that warrant the test.
4. Include necessary medical history: Record the patient's relevant medical history, including any current medications, past illnesses, allergies, surgeries, or chronic conditions. This information helps the testing facility or medical professional better understand the patient's overall health and any potential risks during the test.
5. Specify any previous test results: If the patient has undergone any previous urea breath tests or related diagnostic tests, provide the results, dates, and any additional information that may be necessary for comparison or follow-up purposes.
6. Mention relevant healthcare provider details: Fill in the section where you mention the referring healthcare provider's details accurately. Include their full name, specialty, contact information, and any additional identifiers required.

Who needs urea breath test referral?

1. Individuals with suspected Helicobacter pylori infection: The urea breath test is commonly used to diagnose Helicobacter pylori, a bacteria known to cause various gastrointestinal issues, including ulcers and gastritis. If a patient presents with symptoms suggestive of H. pylori infection, such as frequent abdominal pain, indigestion, or bloating, a referral for the urea breath test may be necessary.
2. Patients with a history of gastric ulcers: If a patient has a history of gastric ulcers, their healthcare provider may recommend a urea breath test to check for H. pylori infection. Since this bacteria is a leading cause of gastric ulcers, detecting its presence or absence can guide proper treatment and management.
3. Follow-up after H. pylori treatment: After completing a course of antibiotics or other medications to eradicate H. pylori, a follow-up urea breath test referral might be necessary. This test helps determine if the treatment was successful in eliminating the bacteria from the patient's digestive system.
4. Assessment of treatment effectiveness: In certain situations, a urea breath test referral may be needed to assess the effectiveness of a prescribed treatment for H. pylori infection or related conditions. This allows the healthcare provider to evaluate the patient's response to the treatment and make any necessary adjustments.

Note: It is important to consult with a healthcare professional for specific guidelines and indications regarding urea breath test referrals. The information provided here is for general understanding and should not substitute professional medical advice.

For pdfFiller’s FAQs

What is urea breath test referral?

Urea breath test referral is a medical procedure used to diagnose Helicobacter pylori infection by measuring the levels of urea in a patient's breath after ingesting a specific substance.

Who is required to file urea breath test referral?

The referring healthcare provider or physician is required to file the urea breath test referral.

How to fill out urea breath test referral?

To fill out a urea breath test referral, the referring provider must include patient information, reason for referral, and any relevant medical history.

What is the purpose of urea breath test referral?

The purpose of a urea breath test referral is to diagnose Helicobacter pylori infection, which can cause various gastrointestinal disorders.

What information must be reported on urea breath test referral?

The urea breath test referral must include patient demographics, medical history, reason for referral, and any relevant clinical findings.

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