eConsultant, Request for Specialist Advice – Neurology

<<Practice/Location:Location Name>>
<<Practice/Location:Address>>

<<Miscellaneous:Date (short)>>

NE41010008F
eConsultant Neurology
Mater Health Services
Raymond Terrace
South Brisbane Qld 4101

NB. This service is for patients 16 years and over only

Re: <<Patient Demographics:Full Details>>

Thank you for the opportunity to seek your opinion / advice regarding <<Patient Demographics:Full Name>> <<Patient Demographics:ATSI>>

Reason for seeking opinion and management: 
Question 1. <<Reason for seeking opinion and management?>>
Question 2. <<2nd Reason for seeking opinion and management?>>

<<Patient Demographics:First Name>>currrent medications are: <<Clinical Details:Medication List>>

Allergies: <<Clinical Details:Allergies/Adverse Reactions>>

Height: <<Height>>
Weight: <<Weight>>
Blood Pressure: << Blood Pressure>>
Smoking History: <<Clinical Details:Smoking>>
Alcohol Consumption: <<Clinical Details:Alcohol>>

Past Medical History: <<Clinical Details:History List>>

Investigations: <<Summary:Investigation Results (Selected)>>

If you wish to send correspondence with an RFA there is an option to send a second message with only PDF attachments: right click on the little “m” symbol in taskbar & select “create new message (PDF)”.

Yours Sincerely,

<<Doctor:Name>>
<<Doctor:Qualifications>>
<<Doctor:Provider Number>>