YYGNEw9010+ + + @SERV0010 GNEwGNEw9010@8@q@@@@T@@@@7@o@@@GNEw GNEw9010@8@q@@@@T@@@@7@o@@@GNEweparator 4D_enable 4D_checkableGNEw9010GNEweparator 4D_enable 4D_checkableGNEw9010GNEw GNEw9010@8@q@@@@T@@@@7@o@@@ Page ]ZX*Page number0001 Re: ] JBO5& DOB: ] JBO5 >@@CCGNEw GNEw9010@@8@U@q@@@@@@@7@T@p@ Page ]ZX*Page number0002 Re: ] JBO5& DOB: ] JBO5 >@@CCTRPweparator 4D_enable 4D_checkableTRPw0010IRPXIRPUVT$m dXXIRPWNorth Lakes - Admin Room on LU 4dXXA4+FNIwDoConfirmq@1FNIw0010 %MRPwMRPw4010/= +HHHH?XIPw XIPw301BORPweparator 4D_enable 4D_checkablePRPw1010TNFw TNFw0010#Times New RomanArialCalibri Arial NarrowSymbol WingdingsCambriaTimes New Roman CETimes New Roman CyrTimes New Roman GreekTimes New Roman TurTimes New Roman (Hebrew)Times New Roman (Arabic)Times New Roman BalticTimes New Roman (Vietnamese)Arial CE Arial Cyr Arial Greek Arial TurArial (Hebrew)Arial (Arabic) Arial BalticArial (Vietnamese) Calibri CE Calibri Cyr Calibri Greek Calibri TurCalibri BalticCalibri (Vietnamese) Cambria CE Cambria Cyr Cambria Greek Cambria TurCambria BalticCambria (Vietnamese)LTSwNormalor 4D_enable 4D_checkableLTSw0010PRPw1010  TTSw1010ABATw2010Times New Roman MNHHS Central Patient Intake  Maternity >>>>> Phone: 1300 364 938 Booking-In>>>>  Fax: 1300 364 952  Referral >  >> > Secure electronic transfer to: (MQ40290004P) >  (Attach label or enter URN: ) @@8@U@q@@@@@@@7@T@p@ Please complete patient contact details in full--to allow us to contact your patient promptly>@@@D@D Patient details>(\A(\ABB>BBCC Re: >FJAFJABB] JBO5& Date of birth: ] JBO5 >qAqACC @@8@U@q@@@@@@@7@T@p@Address: ] JBO5 ] JBO5H ] JBO5 ] JBO5, ] JBO5+ @p@T@7@@@@@@@q@U@8@Home Ph: ] JBO5 @@8@U@q@@@@@@@7@T@pWork Ph: ] JBO5! @@8@U@q@@@@@@@7@T@p@Mobile Ph: ] JBO5J >@@BB Next of Kin: >BBBB Contact number: >H.AH.ABB Relationship to patient: >)BB=C=C Interpreter Required? >AACC Language? >`@`@BB Aboriginal or Torres Strait Islander origin?>zAzACC Will the Child Identify of Aboriginal or Torres Strait Islander origin? >`׳A`׳ACC>BBCC Specialty referred to: ___ CabooltureHospital - Dr Mahilal Ratnapala, Director of Obstetrics and Gynaecology ___ Redcliffe Hospital - Dr Graeme Jackson, Director of Obstetrics and Gynaecology ___ RBWH - A/Prof Rebecca Kimble, Clinical Director Obstetrics Fax: 1300 364 952 Phone: 1300 364 938 @8@q@7@p@Secure electronic transfer to: MNHHS CPI (MQ40290004P) @8@q@7@p@ Referring doctor details>أ=أ=CC: ] JBO5  ] JBO5 ] JBO51 ] JBO5 ] JBO5 ] JBO5 Phone: ] JBO5 Fax: ] JBO5 >AACC Provider No: ] JBO5 !  Clinical Details - Current Pregnancy>>>bCbC LNMP: ] JBO5m Certain? EDD: ] JBO5m  Last pap smear:  Screening & Assessment - Current Pregnancy>>A>ACC>BBCC>BBCC  Dating scan (if required)>QAQACC>BB=C=C>BBbCbC>BBCC>BBCC>BBCC>BBCC>BBCCDiscussed: > WA WACCOrdered: > Nuchal translucency + first trimester serum screen (11-13 weeks + 6 days)>~A~ACCDiscussed: > WA WACCOrdered: > Chorionic Villus Sampling (CVS)>p~Ap~A=C=C>BBbCbC>BBCC>BBCC>BBCC>BBCC>BBCCDiscussed: > WA WACCOrdered: >  Amniocentesis >AABB>BBCC>BB=C=C>BBbCbC>BBCC>BBCC>BBCC>BBCC>BBCCDiscussed: > WA WACCOrdered: > Non-invasive prenatel testing (NIPT)>pApAbCbC>BBCC>BBCC>BBCC>BBCC>BBCCDiscussed: > WA WACCOrdered: >  Morphology diagnostic ultrasound (18-20 weeks) >AACC>BBCC>BBCC>BBCCDiscussed: > WA WACCOrdered: >  Routine antenatal tests orders at: (please send copies with referral) >AAbCbC>BBCC>BBCC  Significant obstetric history: Gravida: >zAzABBParity: >(A(ACCMiscarriages: >x=Ax=ACCEctopics: >P3AP3ACCTOP: >G@G@CC  Past Obstetric History:  Significant medical/surgical history: ]jj\JBO5JNKOT@NRTX ShowProblems_Short Medication List: ]ddVJBO5DNKOT@NRTX Show_Scriptsv  Allergies: ]ffXJBO5FNKOT@NRTX Show_Allergies. Investigations: Smoking Status: ]bbTJBO5BNKOT@NRTX SmokingInfo Alcohol: BMI: Other comments: (eg social concerns) @@8@U@q@@@@@@@7@T@p@Signed electronically: ] JBO5  Date: ]zzlJBO5ZNKOT@NRTX& Show_CurrentDatev@ !@@ @D@h@@@@@@@@d@@@ MNHHS Maternity Referral v6.2 Genie 180701