Get the free Fibroscan referral form - Northern Health
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This document is a referral form for liver FibroScan procedures, intended for use by general practitioners or clinicians within the South Eastern Sydney Local Health District.
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How to fill out fibroscan referral form
How to fill out fibroscan referral form
01
Obtain the fibroscan referral form from your healthcare provider or clinic.
02
Fill in your personal details, including your name, date of birth, and contact information.
03
Provide your medical history, including any relevant conditions or symptoms.
04
Indicate the reason for the referral, such as suspected liver disease or monitoring of known liver conditions.
05
Include any relevant test results or previous imaging studies, if applicable.
06
Sign and date the form to authorize the referral.
07
Submit the completed form to your healthcare provider's office or directly to the facility performing the fibroscan.
Who needs fibroscan referral form?
01
Patients experiencing symptoms of liver disease, such as jaundice, fatigue, or abdominal pain.
02
Individuals with risk factors for liver disease, including obesity, diabetes, or a history of alcohol use.
03
Patients with known liver conditions who require monitoring of liver stiffness or fibrosis.
04
Individuals who have abnormal liver function tests or imaging studies suggestive of liver issues.
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What is fibroscan referral form?
The fibroscan referral form is a document used by healthcare providers to refer patients for a non-invasive liver stiffness measurement using FibroScan technology, which helps assess liver health.
Who is required to file fibroscan referral form?
Healthcare providers, such as primary care physicians or specialists, are required to file the fibroscan referral form when they determine that a patient needs a liver assessment.
How to fill out fibroscan referral form?
To fill out the fibroscan referral form, the healthcare provider should include patient information, medical history, reasons for referral, and any relevant clinical findings that support the need for the fibroscan.
What is the purpose of fibroscan referral form?
The purpose of the fibroscan referral form is to ensure appropriate patients are evaluated for liver stiffness, aiding in the diagnosis and management of liver diseases such as fibrosis and cirrhosis.
What information must be reported on fibroscan referral form?
The information that must be reported on the fibroscan referral form includes patient's name, date of birth, contact details, physician's name, clinical indications for the referral, and any pertinent medical history.
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