Respiratory Testing Services All Appointments Lung ... · Respiratory Testing Services Dr Peter...
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Transcript of Respiratory Testing Services All Appointments Lung ... · Respiratory Testing Services Dr Peter...
P L E A S E S E E R E V E R S E F O R P A T I E N T I N S T R U C T I O N S A N D B O O K I N G D E T A I L S
R e s p i r a t o r y T e s t i n g S e r v i c e s
Dr Peter Bremner MD MBChB FRACPDr Quentin Summers DM MBBS FRACP
All AppointmentsTelephone: (08) 9381 3024
Fax: (08) 9381 3899Email: [email protected]
P A T I E N T D E T A I L S
Surname
First Name Date of Birth / /
C L I N I C A L H I S T O R Y
Smoker Current c
Ex c
Never c
I N V E S T I G A T I O N S
c 1. FULL PULMONARY FUNCTION
c 2. SPIROMETRY c
c 3. BRONCHIAL PROVOCATION Histamine c Mannitol c URGENT
c 4. OXYGEN ASSESSMENT Exercise Oximetry c REPORT
c 5. SKIN PRICK TESTS REQUIRED
c 6. RESPIRATORY MUSCLE STRENGTH
c 7. ALTITUDE SIMULATION
c 8. CLINICAL CONSULTATION P. Bremner c Q. Summers c First Available c
R E F E R R I N G D O C T O R
Name Copy to:
Address
Signature Date
MidlandMurdoch (St John of God Medical Clinic)Subiaco (St John of God Medical Clinic)
For All Appointments - Tel: (08) 9381 3024 Fax: (08) 9381 3899 Email: [email protected]
Lung Function ServicesRespiratory Testing
Dr Peter Bremner Dr Quentin Summers
F o r a l l a p p o i n t m e n t s p l e a s e t e l e p h o n e : ( 0 8 ) 9 3 81 3 0 2 4
A P P O I N T M E N T D E T A I L S
Date
Time
Location
Amount Payable on the Day $
Methods of Payment Available: Cash, Cheque, Eftpos or Credit Card
L O C A T I O N S
Subiaco Murdoch Midland
CAMBRIDGE ST
ST JOHN OF GOD HOSPITAL
CLINIC
McC
OU
RT S
T
MU
RDO
CH D
R
SOUTH ST
FREE
WAYHOSPITAL
WEXFORDCLINIC
THE CRESCENT
DOCTOR’S ROOMS
KEAN
E ST
GT EASTERN HWY
I M P O R T A N T P A T I E N T I N S T R U C T I O N S
FULL PULMONARY FUNCTION TEST - SPIROMETRY - BRONCHIAL PROVOCATION• On the day of the test: Do not smoke• 6 hours before the test: Do not take Ventolin, Bricanyl, Atrovent, Airomir, Asmol• 12 hours before the test: Do not take Serevent, Oxis, Symbicort, Seretide, Singulair, Accolate,
Flutiform, Foradile• 24 hours before the test: Do not take Spiriva, Onbrez, Seebri• Continue all other medications
BRONCHIAL PROVOCATION (IN ADDITION TO THE ABOVE INSTRUCTIONS)• On the day of the test: Do not take Intal Forte, Tilade or Theophylline• 3 days before the test: Do not take antihistamine medication, some cough mixtures may contain
antihistamine (please check with your pharmacist)• Continue all other medications
SKIN PRICK TEST• 3 days before the test: Do not take antihistamine medication, some cough mixtures may contain
antihistamine (please check with your pharmacist)• Continue all other medications
Please contact our rooms on 9381 3024 for advice as your test may need to be rescheduled; if you have taken, or need to take, any of the above medications within these time restrictions; if you are unsure whether to take a medication; if you are experiencing cold and flu or respiratory infection symptoms and/or taking prescription medication (eg. antibiotics) or over the counter medication (expectorants, decongestants). Vigorous exercise should not be performed on the day of the test.
Suite 323, Level 325 McCourt Street
St John of Gold Medical Clinic
Suite 20, Level 13 Barry Marshall ParadeWexford Medical Centre
23 The CrescentMidland Medical Specialist Centre