appt referral cardiology - genesiscare · dr vincent paul t 9480 3060 dr peter purnell t 9400 6111...
TRANSCRIPT
Referral CardiologyAPPT DATE/TIME
PATIENT NAME DATE OF BIRTH
ADDRESS PHONE & EMAIL
CURRENT MEDICATIONS PATIENT HISTORY
● Hypertension
● Dyslipidaemia
● Family history
● Diabetes
● Smoker
CLINICAL DETAILS REFERRAL FOR
● Cardiologist consultation
● Rapid access chest pain assessment
● Heart failure management clinic
● Arrhythmia management clinic
INVESTIGATIONS REQUESTED
● 1. Echocardiogram
● 2. Exercise stress test
● 3. Stress echo
● 4. Dobutamine stress echo
● 5. Holter monitor (24 hour)
● 6. Patient Activated Recorder(7 day event monitor)
● 7. Ambulatory BP Monitor(not covered by Medicare)
● 8. Resting ECG
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V05/July
19
[email protected] | genesiscare.com
REFERRING DOCTOR COPY TO
Your doctor has recommended that you use GenesisCare for your test. Should you wish to use another provider, please discuss this with your doctor first.
To prepare for your test, please visitgenesiscare.com/cardiology
Formerly:
SIGNATURE/DATE.ÓÌÈÚÌ ×ÙÐÕÛǒ ÚÐÎÕ and ËÈÛÌ
[email protected] | genesiscare.comFormerly:
Cardiologists Centre Locations
METRO
● CockburnHealth & Community CentreSuite 11, 11 WentworthPde SuccessT 6332 2300 | F 6332 2310
● JoondalupShenton HouseLevel 3, 57 Shenton AvenueT 9400 6161 | F 9400 6100
● Kalamunda37 Elizabeth StreetT 9480 3000 | F 9321 1012
● Midland23 The CresentT 9480 3000 | F 9321 1012
● MurdochWexford Medical CentreLevel 4, Suite 68-72,3 Barry Marshall ParadeT 6332 2300 | F 6332 2310
● NedlandsHollywood Medical CentreSuite 20-21, 85 Monash AvenueT 6389 9100 | F 6389 1835
● PerthMount Medical CentreSuite 3, 140 Mounts Bay RoadT 9480 3000 | F 9321 1012
● YokineDR7 Medical CentreCorner Royal Street andWanneroo RoadT 9480 3000 | F 9321 1012
REGIONAL
● AlbanyAmity Health136-138 Lockyer AvenueT 9480 3000 | F 9321 1012
● BunburySouth West Health CampusSuite 21 - Testing servicesSuite 13 - Consulting servicesCorner of Bussell Highwayand Robertson DriveT 9720 3400 | F 9720 3410
● Busselton19 Albert StreetT 9751 6000 | F 9751 6010
● DenmarkDenmark Health Service50 Scotsdale RoadT 9480 3000 | F 9321 1012
● DunsboroughSuite 4, 54 Dunn Bay RoadT 6332 2360 | F 6332 2310
● KarrathaKarratha Health CampusOutpatients Department62 Balmoral RoadT 9144 7777 | F 9144 7790
● MandurahSuite 1, 5 Murdoch Drive,T 9584 6500 | F 9584 6520
● ManjimupWarren District HospitalHospital AvenueT 9720 3400 | F 9720 3410
● Margaret RiverMargaret River Hospital17 Farrelly Street (Echo only)Margaret River Surgery1 Station Road (Consulting)T 9720 3400 | F 9720 3410
● Port Hedland34 Colebatch WayT 9174 1380 | F 9174 14050
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19
APPOINTMENT
Date
Time
Holters Only
● Greenwood1 Daley Street
● Rockingham101 Read Street
T 9480 3000 | F 9321 1012
● Dr Stefan BuchholzT 9720 3451
● Dr Randall HendriksT 6332 2360
● Dr Mark IrelandT 9480 3060
● Dr Ben KingT 9480 3060
● Dr Donald LatchemT 6332 2360
● Dr Allison MortonT 9720 3420
● Dr Mark NidorfT 9480 3060
● Dr Vincent PaulT 9480 3060
● Dr Peter PurnellT 9400 6111
● Dr Pradyot SaklaniT 9480 3060
● Dr Nigel SinclairT 9480 3060
● Dr Isabel TanT 9400 6116
● Dr Angus ThompsonT 9480 3060
● Prof Peter ThompsonT 9480 3060
● Dr Alan WhelanT 6332 2360
● Dr Xiao-Fang XuT 6332 2360