CONSULTANT GASTROENTEROLOGISTS & PHYSICIANS · Referral î ì î î7 Dr Keong Lim MBBS (Hons),...
Transcript of CONSULTANT GASTROENTEROLOGISTS & PHYSICIANS · Referral î ì î î7 Dr Keong Lim MBBS (Hons),...
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Referral22022017
Dr Keong Lim MBBS (Hons), FRACP Dr Kee Ooi MBBS, FRACP
Dr Linus Chang MBBS (Hons), MRCP, FRACP Dr Sean Szetoo MBBS, FRACP
CONSULTANT GASTROENTEROLOGISTS & PHYSICIANS
LOGAN ENDOSCOPY
Westpac House
Unit 2, 3276 Mt Lindesay Hwy (Beaudesert Rd)
Between Browns Plains Rd & Janita Dr
BROWNS PLAINS 4118
PATIENT’S NAME ………………………………….. CONTACT NO: …………………
DOB: …../…./……
CLINICAL HISTORY & CURRENT THERAPY
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Consultation Warfarin Aspirin
Gastroscopy & pre test consultation Anticoagulants Plavix/Iscover
No food for 8 hours, no water or fluids for 6 hours before procedure.
If you must take prescription medications (except diabetic medication), this can be
taken up until 4 hours before procedure with a small sip of water.
Colonoscopy & pre test consultation
(Special preparations & instructions given at time of consultation)
Referring Dr ………………………… Signature ……………………………
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Provider No ................................... Date: ……………………………
This Referral Must Be Produced At Time Of Appointment
Appointments: (07) 3809 2893
Mobile: 0481 394 818
Fax: (07) 3809 2895
Website: loganendoscopy.com.au
Email: [email protected]
http://loganendoscopy.com.aumailto:[email protected]
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Referral22022017
GENERAL INFORMATION FOR PROCEDURES
A responsible adult MUST accompany you to provide transport home and
supervise your recovery, as you will be placed under sedation. Otherwise,
your procedure may be cancelled or you may require a prolonged stay in
recovery.
You cannot drive or operate machinery for 12 hours after the procedure.
Please notify the Doctor of any allergies or other medical problems.
Please refer to our website (loganendoscopy.com.au) for more information.
Estimated Cost of Procedures
Please use the space provided below to record the estimate of fees which will
be given to you by booking staff when making your appointment.
Facility Fee Quoted $…………………… Appointment:
Date:
Bowel Prep Kit Fee $…………………… Time:
(Bowel Prep kit fee applies to Colonoscopy Procedure Only)
LOGAN ENDOSCOPY - BROWNS PLAINS
http://loganendoscopy.com.au