Fillable BORDER CARDIOLOGY & RESPIRATORY CENTRE (Australian National University)

Fill Online, Printable, Fillable, Blank BORDER CARDIOLOGY & RESPIRATORY CENTRE (Australian National University) Form

Use Fill to complete blank online AUSTRALIAN NATIONAL UNIVERSITY pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

BORDER CARDIOLOGY & RESPIRATORY CENTRE (Australian National University)

On average this form takes 7 minutes to complete

The BORDER CARDIOLOGY & RESPIRATORY CENTRE (Australian National University) form is 2 pages long and contains:

  • 0 signatures
  • 29 check-boxes
  • 13 other fields

Country of origin: AUSTRALIA
File type: PDF

Australia forms for Australian National University

BROWSE AUSTRALIAN NATIONAL UNIVERSITY FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Daintree Allied and Specialist Health
7 Daintree Way, West Wodonga 3690
Phone: (02) 02 6059 2300
Fax: (02) 02 6059 8407
Hours: 9.00 am – 5.00pm Monday-Friday
Tests are performed by appointment
Appointment date
Time
Name
Address
DOB Phone
Examination requested
ECG studies
q 12 lead ECG
q 24 hours Holter Monitor
q Extended Holter Monitor
(If 24 hour Holter Monitor is non-diagnostic)
72 hours, unless specified otherwise
Blood pressure studies
q 24 hours Blood Pressure Monitor ABPM
Echocardiography
q Transthoracic Echocardiogram – TTE
Pacemaker Clinic
q Pacemaker check
q ICD check
q Reveal Implantable Device check
Respiratory studies
q Spirometry & Oximetry
q Gas transfer study – TLCO
q Lung volumes – Bodyplethysmography
q 6 minute walk test – 6MWT
q Arterial blood gas analysis – ABG
q Home Oxygen Assessment includes
Spirometry & Oximetry, TLCO, 6MWT, ABG
q Respiratory muscle strength – MIP & MEP
Exercise Stress Test
q Exercise Stress Test
Clinical notes / medications
Referring doctor’s name, address, phone, provider number
Copies to:
Signature
Date
BORDER CARDIOLOGY & RESPIRATORY CENTRE
WE ARE HERE
ECG studies
q 12 lead ECG: Wear loose clothing. Allow 15 minutes.
q 24h Holter monitor: Allow 20 minutes. You will be wearing a small monitor for 24 hours. You will be
able to continue your normal daily activities but unable to bathe, shower or go near a welder.
q Extended Holter monitor: Allow 20 minutes. You will be wearing a small monitor for 3 days or longer.
You will be able to continue your normal daily activities but unable to go near a welder.
Blood pressure studies
q 24h Blood pressure monitor: Allow 20 minutes. You will be wearing a small monitor for 24 hours. You will be able
to continue your normal daily activities but unable to bathe, shower or go near a welder.
Echocardiography
q Echocardiogram – transthoracic (TTE): Allow 1 hour. Ultrasound examination of the heart. Wear
loose, comfortable clothing, preferably trousers/skirt & top/shirt (not a dress).
Exercise stress test
q Exercise stress test: Allow 45 minutes. You will be exercising on a treadmill while your heart rate is
monitored. Bring a short-sleeved, loose top/shirt and a pair of comfortable flat-soled shoes or runners
Some heart and blood pressure medication may need to be stopped 24-48 hours before the test. Please
discuss with your doctor. Further instructions are issued when the appointment is made.
Respiratory studies:
Do not smoke on the day of the test. Bring your inhalers and spacer with you to the test. Some inhalers or
respiratory medication may need to be stopped 24-48 hours before the test. Please discuss with your doctor.
Further instructions are issued when the appointment is made.
q Spirometry & Oximetry: Allow 30 minutes.
q Gas transfer study – TLCO: Allow 30 minutes.
q Lung volumes – Bodyplethysmography: Allow 1 hour.
q Respiratory muscle strength MIP & MEP: Allow 30 minutes.
q 6min walk test – 6MWT: Wear loose comfortable clothing and a pair of comfortable flat-soled shoes
or runners. This may be repeated with oxygen. Allow 15 minutes.
q Arterial blood gas analysis – ABG: Blood will be taken from an artery in your wrist.
q Home oxygen assessment includes spirometry & oximetry, 6min walk test, ABG: Allow 1 hour. Instructions
will be given at the time of making appointment. Cease oxygen therapy if possible a half hour prior to the
appointment.
Pacemaker Clinic: Allow 30 minutes.
Patient Instructions
WODONGA
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

BORDER CARDIOLOGY & RESPIRATORY CENTRE (Australian National University)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 15 October 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document