Luton and Dunstable Hospital ERS Services

Size: px
Start display at page:

Download "Luton and Dunstable Hospital ERS Services"

Transcription

1 Please see below the current list of all L&D services available for booking on the ESR/C&B system. This list can be downloaded by visiting the page of our GP website. This list will be regularly updated so please visit the page above to keep up to date with all our services on the ESR/C&B system. For any queries please our Outpatients Booking Dept Manager 2WW 2WW Bone N Service not available at L&D 2WW 2WW Brain Y All referrals to Luton must be discussed by the referrer with a neurologist via medical secretaries: /718295/ WW 2WW Breast Y 2WW 2WW Cancer Unknown Primary N Internal access only to MDT 2WW 2WW Children & Young People Y 2WW 2WW Gynaecology Y 2WW 2WW Haematology Y 2WW 2WW Head & Neck Y 2WW 2WW Lower GI Y 2WW 2WW Lung N Weekly MDT for all referral. Waiting for new functions to enable assessment first prior to booking as some patients go direct to diagnostic. 2WW 2WW Sarcoma N Service not available at L&D 2WW 2WW Skin Y 2WW 2WW Upper GI Y 2WW 2WW Urology Y Allergy Allergy N Service not available at L&D Cardiology Arrhythmia Y Cardiology Cardiology Genetics N Service not available at L&D Cardiology Congenital Heart Disease Y Cardiology Heart Failure Y Cardiology Hypertension Y Cardiology Ischaemic Heart Disease Y Cardiology Lipid Management Y Cardiology Not Otherwise Specified Y Cardiology Rapid Access Chest Pain inc ECG N Referrals to be made via ICE, backup is fax to Cardiology Valve Disorders Y Childrens & Adolescent Services Allergy Y Childrens & Adolescent Services Audiology N Service not available at L&D 1of11

2 Childrens & Adolescent Services Cardiology Y Childrens & Adolescent Services Community Paediatrics N Service not available at L&D Childrens & Adolescent Services Dentistry/Orthodontics Y Childrens & Adolescent Services Dermatology Y Childrens & Adolescent Services Developmental/Learning Disabilities Y Childrens & Adolescent Services Diabetes Y Childrens & Adolescent Services Endocrinology Y Childrens & Adolescent Services ENT Y Childrens & Adolescent Services Gastroenterology Y Childrens & Adolescent Services Gynaecology Y Childrens & Adolescent Services Gynaecology & Preganancy Advice N Service not available at L&D Childrens & Adolescent Services Haematology Y Childrens & Adolescent Services Immunology Y Childrens & Adolescent Services Metabolic Disorders Y Childrens & Adolescent Services Nephrology Y Childrens & Adolescent Services Oncology (Establis Disgnosis) Y Childrens & Adolescent Services Ophthal - Not Otherwise Sepcified Y Childrens & Adolescent Services Ophthal - Orthoptics Y Childrens & Adolescent Services Ophthal - Strabismus/Ocular Motility Y Childrens & Adolescent Services Oral Maxillo Facial Y Childrens & Adolescent Services Orthopaedics Y Childrens & Adolescent Services Other Medical Y Childrens & Adolescent Services Plastic Surgery Y Childrens & Adolescent Services Respiratory Y Childrens & Adolescent Services Rheumatology Y Childrens & Adolescent Services Surgery - Not Otherwise Specified Y Childrens & Adolescent Services Urology Y Dentistry & Orthodontics Endodontics N Service not available at L&D Dentistry & Orthodontics Not Otherwise Specified N Dentistry & Orthodontics Orthodontics Y Dentistry & Orthodontics Periodontics N Service not available at L&D Dentistry & Orthodontics Prosthodontics N Service not available at L&D Dentistry & Orthodontics Surgical Dentistry N Service not available at L&D Dermatology Acne Y 2of11

3 Dermatology Basal Cell Carcinoma Y Dermatology Connective Tissue Disease Y Dermatology Cosmetic Camouflage N Service not available at L&D Dermatology Eczema & Dermatitis Y Dermatology Hair Y Dermatology Laser Clinic N Internal access only Dermatology Leg Ulcer Y Dermatology Male Genital Skin Disorder Y Dermatology Nails Y Dermatology Not Otherwise Specified Y Dermatology Oncology (Establis Disgnosis) Y Dermatology Patch Testing for Contact Dermatitis N Internal referrals only to this service. Refer patients using Dermatitis clinic type. Dermatology Psoriasis Y Dermatology Skin Surgery for Benign Lesions Y Dermatology Vulval Skin Disorders Y Diabetic Medicine Erectile Dysfunction Y Diabetic Medicine General Diabetic Management Y Diabetic Medicine Podiatry & Foot N Referral to be made to SEPT (South Essex Partnership Trust) Diabetic Medicine Preganancy and Maternal Y Diabetic Medicine Renal Diabetes Y Dietetics Cardiovascular Disease Risk Assessment N Referrals to be made to SEPT (South Essex Partnership Trust) Dietetics Diabetes N Referrals to be made to SEPT (South Essex Partnership Trust) Dietetics Eating Disorders - see Mental Health N Referrals to be made to SEPT (South Essex Partnership Trust) Dietetics Food Allergy & Intolerance N Referrals to be made to SEPT (South Essex Partnership Trust) Dietetics Gastroenterology N Referrals to be made to SEPT (South Essex Partnership Trust) Dietetics Not Otherwise Specified N Referrals to be made to SEPT (South Essex Partnership Trust) Dietetics Undernutrition N Referrals to be made to SEPT (South Essex Partnership Trust) Dietetics Weight Management N Referrals to be made to SEPT (South Essex Partnership Trust) Ear Nose and Throat Balance/Dizzyness Y Ear Nose and Throat Ear Y Ear Nose and Throat Facial Plastics & Skin Lesions Y Ear Nose and Throat Neck Lump/Thyroid Y Ear Nose and Throat Nose/Sinus Y 3of11

4 Ear Nose and Throat Not Otherwise Specified N Ear Nose and Throat Oncology (Establis Disgnosis) N Ear Nose and Throat Salivary Gland Y Ear Nose and Throat Snoring (not Sleep Apnoea) Y Ear Nose and Throat Throat (incl Voice/Swallowing) Y Ear Nose and Throat Tinnitus Y Endocrinology and Metabolic Medicine Adrenal Disorders Y Endocrinology and Metabolic Medicine Endocrine Pregnancy Y Endocrinology and Metabolic Medicine Gynaecological Endocrinology Y Endocrinology and Metabolic Medicine Lipid Disorders Y Endocrinology and Metabolic Medicine Metabolic Bone Disorders Y Endocrinology and Metabolic Medicine Not Otherwise Specified Y Endocrinology and Metabolic Medicine Oncology (Establis Disgnosis) N Service not available at L&D Endocrinology and Metabolic Medicine Pituitary & Hypothalamic Y Endocrinology and Metabolic Medicine Thyroid/Parathyroid Y GI & Liver (Medicine & Surgery) Colorectal Surgery Y GI & Liver (Medicine & Surgery) Gallstones Y GI & Liver (Medicine & Surgery) Hepatology Y GI & Liver (Medicine & Surgery) Inflamatory Bowel Disease (IBD) Y GI & Liver (Medicine & Surgery) Lower GI (Medical) exc IBD Y GI & Liver (Medicine & Surgery) Oncology (Establis Disgnosis) N GI & Liver (Medicine & Surgery) Upper GI (Incl Dyspepsia) Y General Medicine General Medicine N General Medicine Transient Ischaemic Attack N Fax referrals to Stroke office Genetics Genetics N Service not available at L&D Genito-Urinary Medicine Genito-Urinary Medicine N Service not available at L&D Geriatric Medicine Cognative Disorders N Service under review may be added to ERS Geriatric Medicine Falls Y Geriatric Medicine Metabolic Bone Disease Y Geriatric Medicine Movement Disorders Y Geriatric Medicine Not Otherwise Specified Y Geriatric Medicine Stroke (not TIA) Y Gynaecology Colposcopy N Suspended at L&D until referral pathway clarified. Gynaecology Early Pregnancy Assessment N Self referral 4of11

5 Gynaecology Family Planning N Gynaecology Infertility Y Gynaecology Menopause Y Gynaecology Menstrual Disorders Y Gynaecology Not Otherwise Specified Y Gynaecology Oncology (Establis Disgnosis) Y Gynaecology Pelvic Pain Y Gynaecology Perineal Repairs Y Gynaecology Post Menopausal Bleeding Y Gynaecology Pregancy Advisory Service N Service not available at L&D Gynaecology Psychosexual Y Gynaecology Recurrent Miscarriage Y Gynaecology Urogynaecology/Prolapse Y Gynaecology Vulval & Perineal Lesions Y Haematology Anti Coagulant Y Haematology Clotting Disorders N Will be added to E-RS Haematology Haemoglobinopathies N Will be added to E-RS Haematology Not Otherwise Specified N Will be added to E-RS Haematology Oncology (Establis Disgnosis) N Will be added to E-RS Immunology Auto Immune Disease N Service not available at L&D Immunology Immunodeficiency N Service not available at L&D Immunology Not Otherwise Specified N Service not available at L&D Infectious Diseases Bone & Joint Infection N Service not avilable at L&D Infectious Diseases Chronic Fatigue Syndrome N Service not avilable at L&D Infectious Diseases Fever N Service not avilable at L&D Infectious Diseases HIV N Referral to Luton Sexual Health Service Infectious Diseases Not Otherwise Specified N Infectious Diseases Travel Advice N Infectious Diseases Tropical Infection N Service not available at L&D Infectious Diseases Tuberculosis N Service under review may be added to ERS Infectious Diseases Viral Hepatitis (not Hep A) N Service under review may be added to ERS Mental Health - Adults of all ages N Service not availble at L&D Mental Health - Child and Adolescent N Service not availble at L&D Nephrology Hypertension N 5of11

6 Nephrology Nephrology Y Nephrology Renal Diabetes Y Neurology Cognititve Disorders Y Neurology Epilepsy Y Neurology Headache Y Neurology Neuromuscular Y Neurology Not Otherwise Specified Y Neurology Oncology (Establis Disgnosis) N Service not availble at L&D Neurology Parkinsons/Movement Disorders Y Neurology Stroke (not TIA) Y Neurology Transient Ischaemic Attack N Fax referrals to Stroke office Neurosurgery N Service not availble at L&D Ophthalmology Cataract Y Ophthalmology Cornea Y Ophthalmology Diabetic Medical Retina Y Ophthalmology External Eye Disease Y Ophthalmology Glaucoma Y Ophthalmology Laser (YAG Capsulotomy) Y Ophthalmology Low Vision N This is a community clinic run by Sight Concern Ophthalmology Neuro - Ophthalmology Y Ophthalmology Not Otherwise Specified Y Ophthalmology Occuloplastic/Orbit/Lacrimal Y Ophthalmology Oncology (Establis Disgnosis) N Ophthalmology Other Medical Retina Y Ophthalmology Squint/Ocular Motility Y Ophthalmology Vitreoretinal Y Oral Maxillo Facial Facial Plastics Y Oral Maxillo Facial Head & Neck Lumps (not 2ww) Y Oral Maxillo Facial Not Otherwise Specified Y Oral Maxillo Facial Oncology (Establis Disgnosis) Y Oral Maxillo Facial Oral Surgery Y Oral Maxillo Facial Salivary Gland Disease Y Orthopaedics Foot & Ankle Y Orthopaedics Fracture - non emergency N Fracture Clinic referral fax to of11

7 Orthopaedics Hand & Wrist Y Orthopaedics Hip & Knee Y Orthopaedics Limb Deformity/Reconstruction N Service not availble at L&D Orthopaedics Oncology (Establis Disgnosis) N Service not availble at L&D Orthopaedics Podiatric Surgery N Orthopaedics Shoulder & Elbow Y Orthopaedics Spine - Back Pain (non sciolosist/deformity) Y unpublis due to backlog Orthopaedics Spine - Neck Pain Y unpublis due to backlog Orthopaedics Spine Scoliosis Y unpublis due to backlog Orthopaedics Sports Trauma Y Pain Management Pain Management N Paper referrals until further notice. Palliative Medicine N Service not availble at L&D Respiratory Medicine Allergy Y Service under review may be added to ERS Respiratory Medicine Asthma Y Service under review may be added to ERS Respiratory Medicine COPD Y Respiratory Medicine Cystic Fibrosis Y Respiratory Medicine Interstitial Lung Disease Y Service under review may be added to ERS Respiratory Medicine Not Otherwise Specified Y Respiratory Medicine Occupational Lung Disease Y Respiratory Medicine Oncology (Establis Diagnosis) Y Service under review may be added to ERS Respiratory Medicine Tuberculosis Y Rheumatology Bone/Osteoporosis Y Rheumatology Inflammatory Arthritis Y Rheumatology Musculoskeletal Y Rheumatology Other Autoimmune Rheumatic Disease Y Rheumatology Spinal Disorder Y Sleep Medicine Excessive/Intrusive Sleepiness Y Sleep Medicine Insomnia N Service not availble at L&D Sleep Medicine Parasomnia & other Sleep Disorders Y Sleep Medicine Sleep Apnoes/Sleep disordered breathing Y Surgery - Breast FH Breast Cancer (non 2ww) N Refer direct to Family History Service Surgery - Breast Mamoplasty (non 2ww) N 7of11

8 Specialty Name (on CAB) Clinic Type Publis Surgery - Breast Oncology (Establis Diagnosis) (non 2ww) N Service Comments Surgery - Breast Other Symptomatic Breast (2ww) Y Listed under specialty of 2ww Surgery - Cardiothoracic Y Service not availble at L&D Surgery - Not Otherwise Specified Endocrine Surgery Y Surgery - Not Otherwise Specified Hernia Y Surgery - Not Otherwise Specified Lumps & Bumps Y Surgery - Plastic Basal Cell Carcinoma Y Surgery - Plastic Burns Y Surgery - Plastic Craniofacial Y Surgery - Plastic Gynaecology & Perineal Reconstruction N Service not availble at L&D Surgery - Plastic Laser Y Surgery - Plastic Lower Limb Y Surgery - Plastic Mamoplasty Y Surgery - Plastic Minor Plastic Surgery Y Surgery - Plastic Not Otherwise Specified Y Surgery - Plastic Oncology (Establis Diagnosis) N Service not availble at L&D Surgery - Plastic Upper Limb N Service not availble at L&D Surgery - Plastic Vascular Malformation N Service not availble at L&D Surgery - Vascular Arterial Y Surgery - Vascular Leg Ulcer Y Surgery - Vascular Lymphodema N Service under review may be added to ERS Surgery - Vascular Not Otherwise Specified Y Surgery - Vascular Varicose Veins Y Urology (In) Continence Y Urology Erectile Dysfunction/Andrology Y Urology Haematuria (not 2ww) Y Urology Male Infertility Y Urology Not Otherwise Specified Y Urology Oncology (Establis Diagnosis) Y Urology Prostate Y Urology Urinary Calculus Y Urology Vasectomy N Service not availble at L&D Services without plan to be added to E-Referral 8of11

9 Health Promotion Exercise N Service not availble at L&D Health Promotion Smoking Cesation N Service not availble at L&D Health Promotion Weight Management N Service not availble at L&D Learning Disabilitities Learning Disabilities N Service not availble at L&D Physiotherapy Cardiovascular N Physiotherapy Gynaecological Physiotherapy N Physiotherapy Musculoskeletal N Physiotherapy Neurological N Physiotherapy Not Otherwise Specified N Physiotherapy Obstetric Physiotherapy N Physiotherapy Oncology (Establis Disgnosis) N Physiotherapy Respiratory N Physiotherapy Urological Physiotherapy N Orthotics & Prosthetics Orthotics N TBC Orthotics & Prosthetics Prosthetics N TBC Podiatry At risk Foot N Podiatry Biomechanical N Podiatry Nail Surgery N Podiatry Not Otherwise Specified N Podiatry Podiatric Dermatology N Podiatry Podiatric Health Education N Podiatry Podiatric MSK -inc rheumatology N Podiatry Podiatric Surgery - exc nail surgery N Rehabilitation Obstetrics Antenatal N Obstetrics Diabetes N Obstetrics Endocrine Pregnancy N Obstetrics Genetics N Obstetrics Haemoglobinopathies N Obstetrics Maternal/Foetal Risk N Obstetrics Maternal Medicine N Obstetrics Multiple Pregnancy N Occupational Therapy Upper Limb Splinting N Occupational Therapy Wheelchair/Seating N Service not availble at L&D 9of11

10 Speech and Language Therapy Communication N Speech and Language Therapy Swallowing N Sports and Exercise Medicine N Service not availble at L&D Diagnostic Endoscopy Colinic Imaging Assessment/Advice N No direct to test service at L&D Diagnostic Endoscopy Flexible Sigmoidoscopy N No direct to test service at L&D Diagnostic Endoscopy Gastroscopy N No direct to test service at L&D Diagnostic Imaging Bone Density Scan (Dexa) N Requests direct to Imaging Diagnostic Imaging CT N Diagnostic Imaging Fluoroscopy & Barium Studies N Diagnostic Imaging Intravenous Urogram (IVU) N Diagnostic Imaging MRI N Diagnostic Imaging Nuclear Medicine N Diagnostic Imaging Ultrasound N Diagnostic Imaging Plain Xray N Diagnostic Pathology Blood Tests N Diagnostic Physiological Measurement Audiology - Hearing Assess / Reassess N Diagnostic Physiological Measurement Audiology - Hearing Aid Assess and Fit N Diagnostic Physiological Measurement Cardiac Physiology - BP Monitoring N Diagnostic Physiological Measurement Cardiac Physiology - ECG N Diagnostic Physiological Measurement Cardiac Physiology - Echocardiogram N Diagnostic Physiological Measurement Audiology - Hearing Aid Review N Diagnostic Physiological Measurement GI Physiology - Urea Breath Test N Diagnostic Physiological Measurement Neurophysiology - EEG (Routine) N Diagnostic Physiological Measurement Neurophysiology - Nerve Conduction Studies N Diagnostic Physiological Measurement Respiratory - Blood Gas N Diagnostic Physiological Measurement Respiratory - Full Lung Function N Diagnostic Physiological Measurement Pre and Post Exercise ABPI N Diagnostic Physiological Measurement Respiratory - Oxygen Assessment N Diagnostic Physiological Measurement Respiratory - Sleep Apnoea Screening N Diagnostic Physiological Measurement Urodynamics - Free Flow / Residual Urine N Diagnostic Physiological Measurement Vascular -ABPI measurement N Diagnostic Physiological Measurement Vascular -Aortic Anneurysm Assessment N 10of11

11 Health Promotion Exercise N Service not available at L&D Health Promotion Smoking Cesation N Service not available at L&D Health Promotion Weight Management N Service not available at L&D Complimentry Medicine General Medicine N Service not available at L&D Complimentry Medicine Musculoskeletal/Rheumatology N Service not available at L&D Complimentry Medicine Oncology (Establis Disgnosis) N Service not available at L&D Complimentry Medicine Podiatry N Service not available at L&D Complimentry Medicine Psychological Medicine N Service not available at L&D Complimentry Medicine Womens Health N Service not available at L&D 11of11

Referral routes into Secondary Care by Specialty and Clinic January 2017

Referral routes into Secondary Care by Specialty and Clinic January 2017 Referral routes into Secondary Care by Specialty and Clinic January 2017 C&B specialty Clinic / Comments Breast (from 7 th November 2016) (for other symptomatic see Surgery-Breast) Referral route ENT (from

More information

Referral routes into Secondary Care by Specialty and Clinic November 2017

Referral routes into Secondary Care by Specialty and Clinic November 2017 Referral routes into Secondary Care by Specialty and Clinic November 2017 C&B specialty Clinic / Comments Breast (from 7 th November 2016) (for other symptomatic see Surgery-Breast) July 2016 Referral

More information

Long-stay patients methodology Published by NHS England and NHS Improvement

Long-stay patients methodology Published by NHS England and NHS Improvement Long-stay patients methodology Published by NHS England and NHS Improvement July 2018 1 Document Title: Long-stay patients methodology Version number: 1.0 First published: 9 July 2018 Updated: Prepared

More information

2017 ST3 Competition Ratios Medical Specialties

2017 ST3 Competition Ratios Medical Specialties 2017 ST3 Competition Ratios Medical Specialties Applications Received Posts Available Competition Ratio Acute Internal Medicine 245 125 1.96 Allergy 8 3 2.67 Audiovestibular Medicine 9 1 9 Cardiology 361

More information

Live Services on Advice and Guidance on e-referrals as of 02/03/18

Live Services on Advice and Guidance on e-referrals as of 02/03/18 Speciality Service Children's & Adolescent Services ( 420 ) Children's Dermatology @ Croydon University Hospital-RJ6 (ID 7908356) Children's & Adolescent Services ( 420 ) Paediatric Sickle Cell and Thalassaemia

More information

Hybrid Open Access Journals

Hybrid Open Access Journals Wolters Kluwer Health (Medical Research) Limited List of LWW Hybrid and Gold Open Access Journals* Hybrid Open Access Journals Academic Medicine Addictive Disorders & Their Treatment Advanced Emergency

More information

Overseas Vistiors upfront charging tariff 2017/18. James Paget University Hospitals NHS Foundation Trust

Overseas Vistiors upfront charging tariff 2017/18. James Paget University Hospitals NHS Foundation Trust Overseas Vistiors upfront charging tariff 2017/18 James Paget University Hospitals NHS Foundation Trust From 6 April 2015 relevant NHS bodies should only be using the risk-share agreement with commissioners

More information

HEALTH FACILITY SCOPE OF SERVICES

HEALTH FACILITY SCOPE OF SERVICES Kindly fill the herein form specifying the scope of services (inpatient and outpatient) provided by your institution and the present medical professionals level. Health Authority Abu Dhabi Facility Licensing

More information

E-journals Suscribed Under HELINET Consoritum for the Year Dental Faculty. Sl.No. Title Publisher Access Point

E-journals Suscribed Under HELINET Consoritum for the Year Dental Faculty. Sl.No. Title Publisher Access Point 1 American Journal of Orthodontics and Dentofacial Orthopedics Elsevier Science Science Direct 2 Anaesthesia and Analgesia Wilkins Wolter Kluwver 3 Archives of Oral Biology Elsevier Science Science Direct

More information

CCR Keywords Primary keywords

CCR Keywords Primary keywords CCR Keywords Primary keywords 1 Aboriginal health 2 Administration and health services 3 Allied health 4 Anaesthesia and intensive care 5 Biochemistry 6 Cardiology and cardiac surgery 7 Complementary medicine

More information

Lippincott Williams & Wilkins Archive Journal Collection

Lippincott Williams & Wilkins Archive Journal Collection Lippincott Williams & Wilkins Archive Journal Collection Academic Medicine ACSM'S Health & Fitness Journal Addictive Disorders & Their Treatment Advanced Emergency Nursing Journal Advances in Anatomic

More information

Data Dictionary Change Notice NHS Wales Informatics Service Data Standards. Treatment Function Code 950 Nursing. Reference Number: DDCN 2016 / 01

Data Dictionary Change Notice NHS Wales Informatics Service Data Standards. Treatment Function Code 950 Nursing. Reference Number: DDCN 2016 / 01 Data Dictionary Change Notice NHS Wales Informatics Data Standards Subject(s): Approval Status: Data Dictionary Version: Treatment Function Code 950 Nursing This DDCN was approved by the DSCN Sub-Group

More information

Number of Accredited Programs

Number of Accredited Programs Accredited Academic Year 2016-2017 United States Totals are subject to change during current academic year On-Duty 020 Allergy and immunology 79 306 040 Anesthesiology 150 6,421 041 Adult cardiothoracic

More information

Mapping inpatient hospital data across England, Scotland and Wales

Mapping inpatient hospital data across England, Scotland and Wales UK Biobank Mapping inpatient hospital data across England, Scotland and Wales Version 1.2 July 2014 http://www.ukbiobank.ac.uk/ Contents Background... 3 Datasets... 3 Mapped data fields... 4 Source of

More information

Lippincott Williams & Wilkins, Inc. OvidSP

Lippincott Williams & Wilkins, Inc. OvidSP 1 Academic Medicine --- 10402446 http://ovidsp.ovid.com/ovidweb.cgi?t=js&news=n&csc=y&page=toc&d=ovft&an=00001888-000000000-00000 2.934 (2014) 2 ACADEMIC Physician & Scientist - Backfile --- --- http://ovidsp.ovid.com/ovidweb.cgi?t=js&news=n&csc=y&page=toc&d=ovft&an=00754481-000000000-00000

More information

Our business is improving the quality of primary care and creating opportunity for primary care to develop its services.

Our business is improving the quality of primary care and creating opportunity for primary care to develop its services. BICS Our Business Our business is improving the quality of primary care and creating opportunity for primary care to develop its services. Quality of experience care designed around individuals and subpopulations.

More information

New Patient Form. Patient Demographics. Emergency Information. Employment Information. Page 1 of 7. Family Health Chiropractic Care

New Patient Form. Patient Demographics. Emergency Information. Employment Information. Page 1 of 7. Family Health Chiropractic Care Page 1 of 7 Patient Demographics First Name* Last Name* Date Of Birth* Home Phone* Mobile Phone Phone Gender* Email Preferred Communication Street Address 1* Street Addresss 2 Zip* City* State* Emergency

More information

SPECIALTY CPT CODES DESCRIPTION

SPECIALTY CPT CODES DESCRIPTION Primary Care Physicians: Internal Medicine, Family Practice, Pediatrics 71010, 71020, 71021, 71022, 71030, 71100, 71101, 71110, 72010, 72020, 72040, 72050, 72052, 72070, 72080, 72100, 72110, 72114, 72170,

More information

Premium Specialty: Pediatrics

Premium Specialty: Pediatrics Premium Specialty: Pediatrics Credentialed Specialties include: Adolescent Medicine, Pediatric Adolescent, and Pediatrics This document is designed to be used in conjunction with the UnitedHealth Premium

More information

NORTHERN HEALTH AND SOCIAL CARE TRUST. Waiting Times Summary Report

NORTHERN HEALTH AND SOCIAL CARE TRUST. Waiting Times Summary Report NORTHERN HEALTH AND SOCIAL CARE TRUST Waiting Times Summary Report April 2014 1 Waiting Times The Northern Health & Social Care Trust monitors waiting time performance against a number of Departmental

More information

Physicians by Specialty

Physicians by Specialty Physicians by Specialty January 2018 SPECIALTY M.D.'S D.O.'S UNKNOWN TOTAL ABDOMINAL RADIOLOGY 3 0 0 3 ABDOMINAL SURGERY 7 0 0 7 ADDICTION MEDICINE 11 1 0 12 ADDICTION MEDICINE AN 1 1 0 2 ADDICTION MEDICINE

More information

Physicians by Specialty

Physicians by Specialty Physicians by Specialty May 2018 SPECIALTY M.D.'S D.O.'S UNKNOWN TOTAL ABDOMINAL RADIOLOGY 2 0 0 2 ABDOMINAL SURGERY 8 0 0 8 ADDICTION MEDICINE 10 1 0 11 ADDICTION MEDICINE AN 1 1 0 2 ADDICTION MEDICINE

More information

AVMED SPECIALIST/SPECIALTIES REQUIRING MEDICARE REFERRAL

AVMED SPECIALIST/SPECIALTIES REQUIRING MEDICARE REFERRAL Addiction Psychiatry Adolescent Medicine (Family Practice) Adolescent Medicine (Pediatric) Adult Congenital Heart Disease Advanced Heart Failure and Transplant Cardiology Aerospace Medicine Allergy & Immunology

More information

Delirium Avoid it Recognize it Find the cause of it

Delirium Avoid it Recognize it Find the cause of it Delirium Delirium is acute cognitive dysfunction. It has a 20% - 30 day mortality (usually because of underlying conditions). It is associated with increased lengths of hospital stay, increased disability,

More information

Physicians by Specialty

Physicians by Specialty Physicians by Specialty September 2014 SPECIALTY M.D.'S D.O.'S UNKNOWN TOTAL ABDOMINAL RADIOLOGY 3 3 ABDOMINAL SURGERY 6 6 ADDICTION MEDICINE 9 2 11 ADDICTION MEDICINE - AN 1 1 ADDICTION MEDICINE - FP

More information

Appendix A Residents and Fellows Cardiopulmonary Resuscitation (CPR) Certification Requirements by Program

Appendix A Residents and Fellows Cardiopulmonary Resuscitation (CPR) Certification Requirements by Program Appendix A Residents and Fellows Cardiopulmonary Resuscitation (CPR) Certification Requirements by Program PROGRAM Type RESIDENT BLS ACLS PALS NRP ATLS Allergy & Immunology Fellow X X X Anesthesia Dentistry

More information

WELSH INFORMATION STANDARDS BOARD

WELSH INFORMATION STANDARDS BOARD WELSH INFORMATION STANDARDS BOARD DSC Notice: DSCN (AMD) 2014 / 08 Date of Issue: 26 th January Ministerial / Official Letter: N/A Subject: Treatment Function Code Sponsor: Sally Greenway Head of Information

More information

Treatments that require prior authorization by NHS

Treatments that require prior authorization by NHS Treatments that require prior authorization by NHS If you want to apply for the cost reimbursement covering your treatment in Poland please check if you need to apply before your medical travel. Please

More information

PATIENT INFORMATION FORM (WOMEN ONLY)

PATIENT INFORMATION FORM (WOMEN ONLY) PATIENT INFORMATION FORM (WOMEN ONLY) Name: Age: Sex: Birthdate: / / SS # A. Describe briefly your present symptom(s) or the reason(s) for seeing the doctor today: B. Name all illnesses or conditions for

More information

Clinical Summary Note. Digital photographs. Echo Cardiogram. Mammogram. Angiogram. BMD scan Pet scan. Xray US

Clinical Summary Note. Digital photographs. Echo Cardiogram. Mammogram. Angiogram. BMD scan Pet scan. Xray US Ankle brachial inde Radiation Records (H) Eternal econsult Guidelines Updated 12/9/2016 Allergy Allergy Audiology Otorhinolaryngology Breast Clinic BRCA Mutation Family History Ca Breast Genetic Susceptibility

More information

UNC GI Clinics UNC GI Procedures

UNC GI Clinics UNC GI Procedures UNC GI Clinics GI Clinic Phone Tree (for outside physicians and patients): 984-974-6000 Scheduling Office: 984-974-6000, option 2 Front Desk Hillsborough Clinic: 919-595-5942 Meadowmont Clinic: 984-374-5056

More information

Here is the list of journals reviewed by eclips Consult:

Here is the list of journals reviewed by eclips Consult: Here is the list of journals reviewed by eclips Consult: A Academic Emergency Medicine Acta Anaesthesiologica Scandinavica Acta Obstetricia et Gynecologica Scandinavica Acta Ophthalmologica Acta Orthopaedica

More information

Table of Contents (Click on the site)

Table of Contents (Click on the site) Table of Contents (Click on the site) Alberta Children's Hospital East Calgary Health Centre Electromyography Lab Foothills Medical Centre Outreach Health Centres Peter Lougheed Centre Richmond Road Diagnostic

More information

Ambulatory Clinics Directory of clinics The Ambulatory Referral Management system (ARMs) is used in a majority of the clinics. Please browse through our directory below to see the contact information for

More information

RECOMMENDED COURSE ORDER

RECOMMENDED COURSE ORDER Although you have the flexibility to view the videos in any order, we strongly recommend that you watch the videos in the order in which your dashboard presents them regardless of how many videos you view

More information

Ovid-Lippincott Journals

Ovid-Lippincott Journals A&A Case Reports 2325-7237 http://ovidsp.ovid.com/ovidweb.cgi?t=js&news=n&csc=y&page=toc&d=yrovft&an=01720097-000000000-00000 Academic Medicine 1040-2446 http://ovidsp.ovid.com/ovidweb.cgi?t=js&news=n&csc=y&page=toc&d=yrovft&an=00001888-000000000-00000

More information

Physicians by County then Specialty

Physicians by County then Specialty Physicians by County then Specialty January 2014 DALLAM DALLAS COUNTY SPECIALTY MD DO TOTAL FAMILY MEDICINE 1 1 FAMILY PRACTICE 2 1 3 INTERNAL MEDICINE 1 1 OBSTETRICS AND GYNECOLOGY 1 1 TOTAL: 5 1 6 ABDOMINAL

More information

Organisation Type Reference Guide For use with Healthcare Identifiers Service Forms

Organisation Type Reference Guide For use with Healthcare Identifiers Service Forms Ambulance Services Charitable hostels for the aged Government nursing home for the aged Local government hostel for the aged Private charitable nursing home for the aged State government hostel for the

More information

Lippincott Williams & Wilkins Total Access Collection 2019

Lippincott Williams & Wilkins Total Access Collection 2019 Ovid is the exclusive online provider to this collection of over 300 medical and nursing journals published by Lippincott Williams & Wilkins (LWW). The LWW Total Access Collection is an expansive collection

More information

SPECIALTY SAUSHEC EAMC MAMC TAMC NCC WBAMC DARNALL WRAIR AFIP KELLER USUHS NAVY

SPECIALTY SAUSHEC EAMC MAMC TAMC NCC WBAMC DARNALL WRAIR AFIP KELLER USUHS NAVY ARMY FELLOWSHIP TRAINING LOCATIONS ARMY FELLOWSHIP TRAINING LOCATIONS Aerospace Medicine Hyperbaric Medicine Anesthesiology Acute Pain/Regional Anesthesia Cardiac Anesthesia Critical Care Anesthesia Pain

More information

UnitedHealth Premium Physician Designation Program Episode Treatment Groups (ETG ) Description and Specialty

UnitedHealth Premium Physician Designation Program Episode Treatment Groups (ETG ) Description and Specialty UnitedHealth Premium Physician Designation Program Episode Treatment Groups (ETG ) Description and Specialty 666700 Acne Family Medicine, Internal Medicine, Pediatrics 438300 Acute Bronchitis Allergy,

More information

Capitol Hill / Main Building

Capitol Hill / Main Building Capitol Hill / Urgent Care Department Floor Anesthesia Advisory Clinic 2 2A Business Floor 1 West Volunteer Gift Shop Urgent Care 1A 1C 1C Occupational Therapy Physical Therapy Security 1A Urgent Care

More information

Document Folders and Sub Folders

Document Folders and Sub Folders Document Folders and s s Labs - Biochemistry & Hematology Labs - Immunology & Serology Labs - Microbiology & Virology Labs - Pathology Labs - Respiratory & Cardiac Complete Listing Sorted by s Labs - Immunology/Serology

More information

Oklahoma State Board of Medical Licensure and Supervision Certification Boards & SubSpecialties

Oklahoma State Board of Medical Licensure and Supervision Certification Boards & SubSpecialties 100 ABPS - Administrative Medicine 101 ABPS - Anesthesiology 106 ABPS - Board of Certification in Family Medicine Obstetrics (BCFMO) 120 ABPS - BOARD OF CERTIFICATION IN RADIOLOGY 102 ABPS - Dermatology

More information

Choose and Book - Directly Bookable Services Prepared by gallk 03/02/2011 Page 1

Choose and Book - Directly Bookable Services Prepared by gallk 03/02/2011 Page 1 Choose and Book - Directly Bookable Services Prepared by gallk 03/02/2011 Page 1 Below is a current list of services offered by Queens Hospital that are available to book directly through Choose and Book.

More information

Patient Information. Insurance Information

Patient Information. Insurance Information Thoracic Group, PA Hyperhidrosis Center at Thoracic Group PA Robert J. Caccavale, MD Jean-Philippe Bocage, MD (732) 247-3002 Patient Information Name: Date: Date of Birth: Social Security #: Street Address:

More information

Improve the lives we touch through medical education, innovations, research and quality healthcare.

Improve the lives we touch through medical education, innovations, research and quality healthcare. The Clinical Mission New Faculty Orientation FY 2012 Improve the lives we touch through medical education, innovations, research and quality healthcare. Objectives Educate the next generation Advance clinical

More information

Specialty-specific References for DIOs: Expected Time for Coordinator

Specialty-specific References for DIOs: Expected Time for Coordinator Allergy and Immunology Anesthesiology Adult Cardiothoracic Anesthesiology Anesthesiology Critical Care Obstetric Anesthesiology Anesthesiology Regional Anesthesiology and Acute Pain Specialty-specific

More information

ereferral QUICK REFERENCE: Advice Request Reasons for Referral

ereferral QUICK REFERENCE: Advice Request Reasons for Referral ereferral QUICK REFERENCE: Advice Request Reasons for Referral The following is a list of specialties and reasons for referral that can be used to help you complete the Reason For Referral field when you

More information

PLAS/RECON SURGERY PATIENT HEALTH HISTORY

PLAS/RECON SURGERY PATIENT HEALTH HISTORY PLAS/RECON SURGERY PATIENT HEALTH HISTORY Chief Complaint - Please describe the problem that brings you into the office today: Allergies 1. Do you have any allergies? if so, please list To Medications?

More information

VASCULAR SURGERY PATIENT HEALTH HISTORY

VASCULAR SURGERY PATIENT HEALTH HISTORY VASCULAR SURGERY PATIENT HEALTH HISTORY Chief Complaint - Please describe the problem that brings you into the office today: Allergies 1. Do you have any allergies? if so, please list To Medications? To

More information

USMLE STEP 2 CK REVIEW STUDY GUIDE

USMLE STEP 2 CK REVIEW STUDY GUIDE USMLE STEP 2 CK REVIEW STUDY GUIDE 2014 edition Brian Jenkins, MD Although you have the flexibility to view the videos in any order, we strongly recommend that you watch the videos in the order in which

More information

LIST OF MEDICAL FOREIGN & INDIAN JOURNALS 2018

LIST OF MEDICAL FOREIGN & INDIAN JOURNALS 2018 LIST OF MEDICAL FOREIGN & S 2018 S.N. DEPARTMENT FOREIGN HARD COPY E- JOURNALS SOFT COPY INDIAN HARD COPY INDIAN JR SOFT COPY TOTAL JOURNALS 1 ANATOMY 1 2 2 5 2 PHYSIOLOGY 3 3 3 9 3 BIOCHEMISTRY 0 3 4

More information

New Patient Packet. Patient Name: DOB: Age: Address: City: State: Zip: Address: City: State: Zip: Name: Address: Phone: Fax:

New Patient Packet. Patient Name: DOB: Age: Address: City: State: Zip: Address: City: State: Zip: Name: Address: Phone: Fax: New Patient Packet Patient Name: DOB: Age: Sex: Male / Female Height: Weight: PHYSICIAN CARE Primary Care Physician: Address: City: State: Zip: Phone: Fax: Referring Physician (if different from PCP):

More information

LECOM Health Ophthalmology

LECOM Health Ophthalmology Patient Name: Date of Birth: New Patient Questionnaire Your answers will be used by your healthcare provider get an accurate history of your medical conditions and ocular concerns. If you are uncomfortable

More information

Vascular surgery is a specialty that deals with diseases of the vascular system (i.e. arteries, veins

Vascular surgery is a specialty that deals with diseases of the vascular system (i.e. arteries, veins Vascular Surgery Vascular surgery is a specialty that deals with diseases of the vascular system (i.e. arteries, veins and lymphatics). These are managed by medical therapy, interventional procedures,

More information

Elenco dei periodici elettronici in Ovid Full text

Elenco dei periodici elettronici in Ovid Full text Elenco dei periodici elettronici in Ovid Full text A&A Case Reports Academic Medicine Addictive Disorders & Their Treatment Advances in Anatomic Pathology Age & Ageing AIDS AIDS Patient Care & Stds AJN,

More information

Patient Intake Form for Allegany Ear, Nose, & Throat

Patient Intake Form for Allegany Ear, Nose, & Throat Patient Intake Form for Allegany Ear, se, & Throat Patient Name: What brings you to the office today? Who is your primary care doctor? Please list your current medications: Are you allergic to any medications?

More information

UnityPoint Clinic - Cardiology

UnityPoint Clinic - Cardiology UnityPoint Clinic - Cardiology Date Completed: Appointment Date: Name: Age: Birthdate: / / FIRST MIDDLE INITIAL LAST Referred by: Family Dr.: Reason for visit: Describe briefly, include date of onset:

More information

Medical History Form

Medical History Form General: Medical History Form 1. Chief Complaint: What are the main health concerns you wish to address? 2. Current and Past Treatment: Have you received treatment for these problems? Yes No, if yes, which:

More information

PLEASE COMPLETE ALL SECTIONS OF THIS FORM

PLEASE COMPLETE ALL SECTIONS OF THIS FORM PLEASE COMPLETE ALL SECTIONS OF THIS FORM Patient Name: Date of Birth: Referring Doctor? (Name, telephone number and address) Chief Complaint: Why have you come here? How did it start? What are the symptoms?

More information

Patient History Form

Patient History Form Patient History Form Advanced Directive Care Plan? Yes No Name: Birth date: / / Address: Age: Sex: F M STREET DAY YEAR Telephone: Home ( ) CITY STATE DAY YEAR MARITAL STATUS: Divorced Separated Alive/Age

More information

PHYSICIAN (MD/DO) Varies by specialty: $150,000-$700,000. University of Kentucky, University of Louisville, University of Pikeville

PHYSICIAN (MD/DO) Varies by specialty: $150,000-$700,000. University of Kentucky, University of Louisville, University of Pikeville PHYSICIAN (MD/DO) Description A physician diagnoses and treats patients as part of the health care team. There are many different specialties in the career. Education Required Doctorate 8yr + Residency

More information

City State Zip. Cell Phone. Other Phone. Gender Male Female Status Single Married Divorced Widowed. Height Weight EXERCISE Yes No Times per Week

City State Zip. Cell Phone. Other Phone. Gender Male Female Status Single Married Divorced Widowed. Height Weight EXERCISE Yes No Times per Week Patient Name (First Middle Last) Date of Birth Social Security # Address City State Zip Home Phone Work Phone Cell Phone Other Phone Email Place of Birth Occupation Retired Yes No Gender Male Female Status

More information

HEALTH SCIENCES CENTRE 820 SHERBROOK ST Web: GENERAL INQUIRIES Toll Free Number IMPORTANT NUMBERS 24 Hr

HEALTH SCIENCES CENTRE 820 SHERBROOK ST Web:  GENERAL INQUIRIES Toll Free Number IMPORTANT NUMBERS 24 Hr HEALTH SCIENCES CENTRE 820 SHERBROOK ST Web: www.hsc.mb.ca GENERAL INQUIRIES... 787-3661 Toll Free Number... 1 877 499-8774 IMPORTANT NUMBERS 24 Hr Patient Enquiry... 787.3661 Emergency Adult... 787-3167

More information

Questionnaire for Lipedema Patients

Questionnaire for Lipedema Patients Questionnaire for Lipedema Patients Name Date of diagnosis Date Name of physician making diagnosis Do you also have lymphedema? What areas of the body are affected? Outside of thighs Inner thighs Knees

More information

Letter to the AMGA Board of Directors...1 Introduction...3

Letter to the AMGA Board of Directors...1 Introduction...3 Table of Contents Letter to the AMGA Board of Directors...1 Introduction...3 Section I: Executive Summary Survey at a Glance...6 Participant Profile...10 Survey Methodology...18 How to Use This Report...21

More information

For the people of West Cork and surrounding areas. Information for patients and their families. Bantry Urgent Care Centre

For the people of West Cork and surrounding areas. Information for patients and their families. Bantry Urgent Care Centre Bantry Urgent Care Centre For the people of West Cork and surrounding areas Information for patients and their families The Bantry Urgent Care Centre is made up of a Local Injury Unit and a Medical Assessment

More information

Contributors. Thanks to Peter Miller, MD; LCDR Kevin Preston, MD; and Keith Newbrough, MD for their generous contribution of images:

Contributors. Thanks to Peter Miller, MD; LCDR Kevin Preston, MD; and Keith Newbrough, MD for their generous contribution of images: Contributors Thanks to Peter Miller, MD; LCDR Kevin Preston, MD; and Keith Newbrough, MD for their generous contribution of images: Peter Miller, MD, Indiana University School of Medicine Chapter 1: Figure

More information

New Patient Intake Form

New Patient Intake Form New Patient Intake Form Title: (Check one) Mr. Mrs. Ms. Miss Dr. Other First Name Middle Initial Last Name _ Address City State Zip Code Leave Messages on: (Circle one) Home Cell Work Don t leave messages

More information

Please answer all questions in blue or black ink by filling in the blank or circling. SOCIAL HISTORY

Please answer all questions in blue or black ink by filling in the blank or circling. SOCIAL HISTORY PATIENT QUESTIONNAIRE / ASSESSMENT Endocrinology Form Please answer all questions in blue or black ink by filling in the blank or circling. SOCIAL HISTORY Date Phone (H) (W) (C) Age Male Female Marital

More information

New Patient Documentation. Name: (Last) (First) (Middle) Address: (Street) (Apt#) (City) (State) (Zip) Home Phone: ( ) Cell: ( ) Work: ( )

New Patient Documentation. Name: (Last) (First) (Middle) Address: (Street) (Apt#) (City) (State) (Zip) Home Phone: ( ) Cell: ( ) Work: ( ) New Patient Documentation Name: (Last) (First) (Middle) Address: (Street) (Apt#) (City) (State) (Zip) Home Phone: ( ) Cell: ( ) Work: ( ) Age: Birthdate: E Email: Social: Sex: Male Female Height: Weight:

More information

MALE MEDICAL HISTORY FORM (please circle answers/complete blanks) rev 2/2014

MALE MEDICAL HISTORY FORM (please circle answers/complete blanks) rev 2/2014 MALE MEDICAL HISTORY FORM (please circle answers/complete blanks) rev 2/2014 Name: Date of Birth: Today s Date: Where did you get healthcare before? May we request records? Y N (requires signed release)

More information

Cover Comparison for AAMI Health Insurance Basic Hospital Plus

Cover Comparison for AAMI Health Insurance Basic Hospital Plus Cover Comparison for AAMI Health Insurance Basic Hospital Plus Summary of changes effective 1 April 2019 Product AAMI Health Insurance Basic Hospital Plus (previously AAMI Health Insurance Starter Hospital)

More information

Application Deadlines

Application Deadlines Anaesthesia PGME Application Deadline Department Website Anaesthesia Fellowships http://www.anesthesia.utoronto.ca/fellowships offered Adult Critical Care PGME Application Deadline Department Website Critical

More information

The Cochrane Library Impact Factor Data Pack

The Cochrane Library Impact Factor Data Pack The Cochrane Library Impact Factor Data Pack When considering the data presented below, please be aware of the following: The dataset we have used to generate impact factors for individual review groups

More information

Partners in health A Unit of vps Health Care

Partners in health A Unit of vps Health Care Medeor Latin. Meaning: I heal World-class healthcare and an unparalleled patient experience. Who are we? We are a multi-speciality, 24x7, family hospital located in the heart of Abu Dhabi. We are committed

More information

Sound View Acupuncture and Chinese Herbs 5410 California Ave SW, #202, Seattle, WA

Sound View Acupuncture and Chinese Herbs 5410 California Ave SW, #202, Seattle, WA Sound View Acupuncture and Chinese Herbs 5410 California Ave SW, #202, Seattle, WA 98136 206.200.3595 Today s date Name Legal name (if different) Phone (primary) (secondary) Address City State Zip Email

More information

AMA PHYSICIAN COUNTS

AMA PHYSICIAN COUNTS AMA PHYSICIAN COUNTS Revised: 7-25-2018 POSTAL COUNTS EMAIL COUNTS Primary Specialty Name Office Based Hospital Staff TOTAL Office Hospital Staff TOTAL Abdominal Radiology 201 35 328 145 26 213 Abdominal

More information

Home Address. City Postal Code Home Telephone # Business Telephone # Address. Emergency Contact Name, Address, Phone#

Home Address. City Postal Code Home Telephone # Business Telephone #  Address. Emergency Contact Name, Address, Phone# Date Name / / last first middle initial Personal Health # - Male Female Home Address City Postal Code Home Telephone # Business Telephone # Cell # E-Mail Address Best way to contact you: Home # Work #

More information

Letter to the AMGA Board of Directors... 1 Introduction... 3

Letter to the AMGA Board of Directors... 1 Introduction... 3 Table of Contents Letter to the AMGA Board of Directors... 1 Introduction... 3 Section I: Executive Summary Survey at a Glance... 6 Participant Profile... 10 Survey Methodology... 19 How to Use This Report...

More information

CHRISTOPHER BROWN D.O. - TRADITIONAL OSTEOPATHY

CHRISTOPHER BROWN D.O. - TRADITIONAL OSTEOPATHY CHRISTOPHER BROWN D.O. - TRADITIONAL OSTEOPATHY REGISTRATION PAGE Date: Name: Tel: 510-526-5256 (Albany) 415-334-1010 (San Francisco) Fax: 510-526-5547 christopherbrowndo@gmail.com DOB: Age: Sex: Address:

More information

Application Deadlines

Application Deadlines Anaesthesia PGME Application Deadline Department Website Anaesthesia Fellowships http://www.anesthesia.utoronto.ca/fellowships offered Adult Critical Care PGME Application Deadline Department Website Critical

More information

Caspian Acupuncture -- Health History Form Anita Tayyebi EAMP, LAc. 652 SW 150 th St Burien WA 98166

Caspian Acupuncture -- Health History Form Anita Tayyebi EAMP, LAc. 652 SW 150 th St Burien WA 98166 Frist Name Last: Date Phone (H) (C) (W) E-mail Address City State Zip Age DOB Place of Birth _ Marital/Partnership Status Preferred Gender Pronoun _ Profession Family Physician Telephone # Referred By

More information

Rowley Hall Hospital. GP Referral Guide. for Private and NHS patients. Rowley Hall Hospital

Rowley Hall Hospital. GP Referral Guide. for Private and NHS patients. Rowley Hall Hospital Rowley Hall Hospital GP Referral Guide for Private and NHS patients Rowley Hall Hospital About Rowley Hall Hospital Rowley Hall Hospital is a leading private hospital with an excellent reputation for delivering

More information

Welcome to our clinic! NEW PATIENT HEALTH QUESTIONNAIRE

Welcome to our clinic! NEW PATIENT HEALTH QUESTIONNAIRE Welcome to our clinic! NEW PATIENT HEALTH QUESTIONNAIRE First Name: Last Name: Date of Birth (mm/dd/yyyy): / / Gender: Male Female Current Occupation: Address: Appt no. Postal Code: Home Phone ( ) - Work

More information

Mercy MS Center New Patient Information

Mercy MS Center New Patient Information Mercy MS Center New Patient Information Last Name: First Name: DOB: MULTIPLE SCLEROSIS HISTORY Reason for clinic visit: I have been diagnosed with MS or NMO (Date diagnosed ) I have not been diagnosed

More information

Application Deadlines

Application Deadlines Anaesthesia PGME Application Deadline Department Website Anaesthesia Fellowships http://www.anesthesia.utoronto.ca/fellowships offered Adult Critical Care PGME Application Deadline Department Website Critical

More information

GASTROENTEROLOGY PATIENT QUESTIONNAIRE - PLEASE PRINT

GASTROENTEROLOGY PATIENT QUESTIONNAIRE - PLEASE PRINT GASTROENTEROLOGY PATIENT QUESTIONNAIRE - PLEASE PRINT Full name: Date: Telephone Number: Age: Address: Email address: CHIEF COMPLAINTS(List the problems about which you came to see the doctor) 1) 2) 3)

More information

Please list any medications you currently taking along with dosage and directions (including birth control, vitamins and OTC medications):

Please list any medications you currently taking along with dosage and directions (including birth control, vitamins and OTC medications): Name: DOB: Date of Appointment: Please list all doctors you currently see (Primary Care Physician and Specialists i.e. Cardiologist): Please list any medications you currently taking along with dosage

More information

Health screening questionnaire

Health screening questionnaire Health screening questionnaire High Road Buckhurst Hill Essex IG9 5HX Tel: 020 8936 1202 Fax: 020 8936 1191 Visit: theholly.com Title: Surname: Forenames: Date of birth: Age: Address: Tel no. (Home): Tel

More information

Name: Date: Referring Provider: What is the nature of your current gynecologic or urologic medical problem (use the other side if necessary).

Name: Date: Referring Provider: What is the nature of your current gynecologic or urologic medical problem (use the other side if necessary). Name: Date: Referring Provider: Age: D.O.B. Race/ ethnicity: What is the nature of your current gynecologic or urologic medical problem (use the other side if necessary). We are interested in learning

More information

McLaren Cardiothoracic and Vascular PATIENT HISTORY FORM

McLaren Cardiothoracic and Vascular PATIENT HISTORY FORM McLaren Cardiothoracic and Vascular PATIENT HISTORY FORM Please complete this form and bring it with you to your appointment Appointment Date Appointment Time Name Referring Physician Date of Birth Please

More information

Electives Catalogue 2019 Derriford Hospital, Plymouth

Electives Catalogue 2019 Derriford Hospital, Plymouth Electives Catalogue 2019 Derriford Hospital, Plymouth A. Cardiothoracic Surgery Page 1 B. Colorectal Surgery Page 1 C. Diabetes, Endocrinology & General Internal Medicine.. Page 2 D. Ear, Nose and Throat..

More information

Letter to the AMGA Board of Directors...1 Introduction...3

Letter to the AMGA Board of Directors...1 Introduction...3 Table of Contents Letter to the AMGA Board of Directors...1 Introduction...3 Section I: Executive Summary Survey at a Glance...6 Participant Profile...10 Survey Methodology...18 How to Use This Report...21

More information

4.1.3 SECONDARY AND TERTIARY HEALTH SERVICES

4.1.3 SECONDARY AND TERTIARY HEALTH SERVICES 4.1.3 SECONDARY AND TERTIARY HEALTH SERVICES Introduction Tertiary Services are specialised health services that are provided in a few Trust sites on a regional basis. Secondary Services are more general

More information

For Office Use Only: MA complete Date of Visit / / mm/dd/yyyy. This form must be scanned into the medical record. Do not remove from clinic.

For Office Use Only: MA complete Date of Visit / / mm/dd/yyyy. This form must be scanned into the medical record. Do not remove from clinic. For Office Use Only: MA complete Date of Visit / / mm/dd/yyyy This form must be scanned into the medical record. Do not remove from clinic. UWMC Women s Health Care Center & SCCA Women s Cancer Center

More information

Letter to the AMGA Board of Directors... 1 Introduction... 3

Letter to the AMGA Board of Directors... 1 Introduction... 3 Table of Contents Letter to the AMGA Board of Directors... 1 Introduction... 3 Section I: Executive Summary Survey at a Glance... 6 Participant Profile... 10 Survey Methodology... 19 How to Use This Report...

More information

In your own words, please write the reason you are here. Please be specific, putting in dates as necessary. Use the back of the form if needed.

In your own words, please write the reason you are here. Please be specific, putting in dates as necessary. Use the back of the form if needed. Name: SS# In your own words, please write the reason you are here. Please be specific, putting in dates as necessary. Use the back of the form if needed. Patient Medical, Surgical and Family History Review

More information

CECILIA P MARGRET MD PhD MPH Child, Adolescent and Adult Psychiatry NE 24th ST Suite 104, Bellevue WA 98007, Phone / Fax: +1 (425)

CECILIA P MARGRET MD PhD MPH Child, Adolescent and Adult Psychiatry NE 24th ST Suite 104, Bellevue WA 98007, Phone / Fax: +1 (425) IDENTIFYING INFORMATION PATIENT INFORMATION FORM Patient's Name: DOB: Ethnicity/race: Gender: Primary language if other than English: Address: Phone: Home/ Mobile/ Work Email: Occupation: Marital Status:

More information