Referring Physicians

We value the trust and confidence of our referring providers. We promise to provide the best care and service, prompt appointment availability and timely communication for your patients.

Fibroscan Order Form

This is offered by Pinnacle at no cost to the patient.
Insurance information and CPT codes are not needed

Patient First Name

Patient Last Name

Patient DOB

Phone

Ordering Provider

Ordering Provider Phone

Ordering Provider Fax

Patients with one or more of the following conditions would benefit from a Fibroscan:

Obesity

Diabetes

Metabolic Syndrome

Age > 50

High Cholesterol

Hypertension

AST or ALT > 20 (and no other reason for elevated numbers)

One of our Board-Certified providers will review the results with the patient and provide recommendations and lifestyle counseling. We will fax a copy of the report to your office. To better counsel the patient, please include the last clinic note and labs. Thank you!

Please fax the completed form, or send your EMR Entry Request to the location of your choice:

AUSTIN - 8015 Shoal Creek Blvd, Suite 114, Austin, TX 78757 - F: (512) 732-9957

GEORGETOWN - 3201 S Austin Ave, Suite 325, Georgetown, TX 78626 - F: (737) 444-8480

NORTH SAN ANTONIO - 5109 Medical Dr, Suite 200, San Antonio, TX 78229 - F: (210) 572-5766

SOUTH SAN ANTONIO - 4243 East Southcross Boulevard Suite 204, San Antonio, Texas, 78222 - F: (210) 441-7959

BROWNSVILLE - 717 N. Expressway 77/83 Suite 6-9 Brownsville, TX 78520 - F: (956) 468-3365

EDINBURG- 2502 W. Trenton Rd. Edinburg, TX 78539 - F: (956) 394-1173

CORPUS CHRISTI - 1521 S Staples St Suite 803, Corpus Christi, TX 78404 - F: (361) 400-5348

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Resources

AGA Risk Stratification and Endocrine NAFLD Guidance
Prevelance of NASH_NAFLD

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