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Idiopathic pulmonary fibrosis (IPF): Suspect-and-test checklist for clinicians

A one-page worksheet that turns the full Idiopathic pulmonary fibrosis (IPF) diagnosis guide into something you can use at the point of care: what to look for, what to order, which results should not end the workup, and who else to test or refer.

Who it is forClinicians and care teams who may see Idiopathic pulmonary fibrosis (IPF) before it is diagnosed, including primary care, the specialists named in the guide, and referral or genetics coordinators.
When to use itWhen Idiopathic pulmonary fibrosis (IPF) is on the differential, when a patient has several red flags, or when you are preparing a referral or a second opinion.

How to use it, section by section

  1. Red flags present: Tick each finding the patient has. They are grouped by body system so you can scan quickly.
  2. Already labeled as: Tick earlier diagnoses on the chart that the sources say are often given first.
  3. Family to test: Note relatives who may need testing, and record when symptoms began and which specialists have already been seen.
  4. Testing, in order: Tick each test as you order it and write the result on its line. The order follows the published sources.
  5. Results that do not rule it out: A reminder of findings that can look reassuring but do not exclude Idiopathic pulmonary fibrosis (IPF).
  6. Specialists: Tick the referral, then write who it went to and any notes.
Two ways to fill it inPrint it blank and write on it, or tick boxes and type on this screen first, then print or save as a PDF. Keep it with the chart or send it with the referral.
PrivacyNothing you type is sent or saved. It stays in this browser tab and disappears when you close it. Use patient initials, not full identifiers.

What it is not: Not a diagnostic score, a protocol or coding advice. It summarizes published sources, and clinical judgment and the treating clinician govern. Every point is sourced in the full Idiopathic pulmonary fibrosis (IPF) guide.

One Letter page. Use your browser's print or save as PDF.Full guide with sources
Suspect-and-test checklist
Idiopathic pulmonary fibrosis (IPF)

Progressive lung fibrosis of unknown cause, mostly after age 60. Exertional dyspnea, dry cough and velcro crackles at the bases call for HRCT.

ICD-10-CMJ84.112Trial Friend for Clinicians

1Red flags present

Symptoms and history

Examination

Imaging

Earlier care

Family and age

2Already labeled as

3Family to test

4Testing, in the order the sources describe

  1. Auscultation at the lung basesBilateral velcro crackles predicted fibrotic ILD on HRCT.
    Result
  2. HRCT chest, noncontrast, volumetricSections of 1.5mm or less; supine inspiratory and expiratory; prone optional.
    Result
  3. Radiology read: 1 of 4 patternsUIP, probable UIP, indeterminate for UIP, or alternative diagnosis.
    Result
  4. Medication and exposure historyHome, work and places visited often, including exposures linked to HP.
    Result
  5. Serologic testing for CTDRecommended by the 2018 guideline for newly detected ILD of unknown cause.
    Result
  6. Serum IgG to potential HP antigensSuggested by the 2020 HP guideline, very low confidence.
    Result
  7. Multidisciplinary discussionUIP or probable UIP in the right setting: IPF without biopsy.
    Result
  8. BAL, surgical biopsy or cryobiopsyFor indeterminate or alternative patterns. Cryobiopsy only at experienced centers.
    Result
  9. Family history; genetic testing where relevantTERT or TERC variants in about 15% of familial pulmonary fibrosis.
    Result

5Results the sources say do not rule it out

  • Inhalers were tried. Only 33% on inhalers before IPF met asthma or COPD criteria.
  • A pulmonologist already saw the patient. In Medicare data 34.7% of first visits came over 3 years before diagnosis.
  • No honeycombing on CT. Probable UIP can still support IPF without biopsy.
  • No exposure found. None is identified in up to 60% of HP patients.
  • No clubbing. Measured prevalence in IPF ranged from 7% to 52%.

6Specialists the sources name

Diagnosis code: J84.112 Idiopathic pulmonary fibrosisCodes patients often carry before diagnosis are listed in the online guide.
Full guide and sourcesEvery point here is sourced in the online guide, which also has a patient note to print.
Trial Friend, trialfriend.com/for-clinicians. Key sources: ATS/ERS/JRS/ALAT 2018 guideline; ATS/ERS/JRS/ALAT 2022 update; ATS/JRS/ALAT 2020 HP guideline; Hoyer 2019 Danish delay study; INTENSITY survey (2018); Lamas 2011 delayed access study; all 22 with links in the online guide. Checked November 11, 2026. A reference checklist for licensed clinicians that summarizes published sources. It is not a diagnostic tool, a score or a protocol, and it does not replace clinical judgment, local practice or the prescribing information. Not coding advice. Trial Friend never receives anything written or typed on this sheet.