02 4910 0591reception@beechnutmedical.com
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Beechnut Medical · Hepatology

FibroScan Referral

Transient elastography for assessment of liver fibrosis and steatosis. A non-invasive scan — no sedation required. Please include recent liver bloods so we can confirm appropriateness and prioritise.

For use by medical practitioners only · 55 Lindsay St, Hamilton NSW 2303 · (02) 4910 0591

1 Patient Details

2 Referring Doctor Details

3 Indication for FibroScan

Please select at least one indication.

4 Recent Liver Blood Tests

Please enter the most recent results. AST, ALT and platelets are used to calculate FIB-4 below — this helps us prioritise and is advisory only.

Calculated FIB-4
—
Enter age/DOB, AST, ALT & platelets
Recommended — but not required

If it hasn't been done recently, we'd suggest a liver aetiology screen so the results are on hand at the scan. It's entirely optional for referral — if it's easier, we're happy to arrange the bloods ourselves, just let us know in the notes.

FBC · UEC · LFTs · coagulation/INR · Hepatitis B (HBsAg, anti-HBc, anti-HBs) · Hepatitis C antibody · iron studies (ferritin, transferrin saturation) · ANA, anti-smooth-muscle & anti-mitochondrial antibodies · immunoglobulins (IgG/IgA/IgM) · caeruloplasmin (if under 40) · alpha-1 antitrypsin · coeliac serology (anti-tTG IgA) · TSH · fasting glucose/HbA1c & lipids · AFP if cirrhosis suspected

5 Risk Factors & Measurements

BMI helps us select the correct probe (M vs XL) for an accurate scan.

6 Clinical Information

By submitting, you confirm the patient is aware of this referral. Information is handled in accordance with the Privacy Act 1988 and stored securely by Beechnut Medical.

Please complete the required fields highlighted above.

Referral received

Thank you. Your FibroScan referral has been submitted to Beechnut Medical. Our team will contact the patient to arrange the scan. For urgent matters please call (02) 4910 0591.

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