Get Fibroscan Request Form V10 - Eastern Health

Filling out the Fibroscan Request Form V10 for Eastern Health can seem daunting, but this guide aims to make the process clear and straightforward. Follow these comprehensive steps to ensure your form is completed accurately and submitted without issues.

Follow the steps to fill out the form online.

1. Click the ‘Get Form’ button to access the Fibroscan Request Form and open it in the editing interface.
2. Begin by entering the patient details. This includes the UR number, date of birth, patient's name, gender, work phone, mobile phone, address, and Medicare number. Be sure to fill in all required fields neatly and accurately.
3. Indicate if an interpreter is needed for the patient. This ensures effective communication during the consultation.
4. In the clinical details section, specify whether a previous liver biopsy was performed. If so, provide the date and relevant information regarding the condition, such as Hepatitis C or NAFLD/NASH.
5. Record the full blood count results along with the dates of testing. This includes measurements for Hb, platelets, GGT, ALT, AST, albumin, and bilirubin levels.
6. Complete the section regarding the previous Fibroscan, including any notes on alcohol consumption and liver function tests. Specify any diagnoses and clinical impressions, indicating fibrosis levels if applicable.
7. Fill in the referral details, including the name of the GP (referrer), their address, email, and provider number. Ensure to write these details in block capitals for better clarity.
8. Select the report distribution preferences. Choose how you would like the report delivered: via post, email, or fax.
9. After completing the form, review all fields for accuracy and clarity. Once verified, you can either save the changes, download, print, or share the completed form as needed.

Complete your documents online and ensure a smooth process for your Fibroscan request.