Your doctor has recommended that you use Repat Radiology. You may choose another provider but please discuss this with your doctor first. Appointment date ........../........../.......... Appointment time ...................... am/pm PATIENT DETAILS Name: Date of Birth: Address: Telephone: Medicare Number: CLINICAL DETAILS EXAMINATION REQUESTED REFERRING DOCTOR DETAILS Creatinine _______________ Previous Contrast Reaction: Yes No COPIES TO DATE DOCTORS SIGNATURE Not for Public Health System Distribution. ALL BOOKINGS AND ENQUIRIES PH: (08) 8275 1906 REPAT RADIOLOGY PROVIDES A BULK BILLING SERVICE FOR ALL MEDICARE ENTITLED PATIENTS. PLEASE BRING ALL PREVIOUS RELEVANT X-RAYS AND YOUR MEDICARE CARD WITH YOU. Modalities offered: Consultant Radiologists: • Digital OPG • Prof Michael Sage • CT Scanning • Prof John Slavotinek • Digital General X-Ray • Dr Nigel Krauel • Digital Fluoroscopy • Dr Chris Whisson • General Ultrasound • Dr Brian Roache • Vascular Ultrasound • Dr Virginia Au • Obstetric Ultrasound • Dr Leigh Mosel • Musculoskeletal Ultrasound • Interventional Ultrasound Request • Dr Matthew J Sampson • Dr Andrew Loja • Interventional Radiology • Dr Saba Hatami • Coronary Artery Calcium Scoring • Dr Anjana Chandy • Dr Pouria Rezaian A TR I A T I O EP N Repatriation General Hospital Daws Road Daw Park South Australia 5041 Telephone (08) 8275 1906 Facsimile (08) 8275 1116 Email [email protected] Web www.repatradiology.com.au R • Dr Mark Sparnon GENERAL H O S P I TA L DAW PARK PATIENT PREPARATION INFORMATION Please note Patients fasting for a procedure who are Diabetic or Insulin dependent need to inform Repat Radiology of this when booking their appointment. Those patients who are on Warfarin (a blood-thinning drug) also need to inform the receptionist when booking their appointment. If fasting for a procedure and you need to take Heart or Blood Pressure Tablets, please take your tablets with a small amount of water. If you are on any other tablets, please bring them with you to take after the procedure. Barium Swallow / Meal / Follow-through and Small Bowel Series Please have nothing to eat or drink for 8 hours (for a Barium Meal, Follow-through or Small Bowel Series) or 4 hours (for a Barium Swallow) before your appointment. You may be required to spend a number of hours in the department if a follow-through or Small Bowel Series is required. Barium Enema - Large Bowel Please obtain a preparation kit from your doctor or from Repat Radiology and follow the instructions carefully. CT Scan - Abdomen and Pelvis Please do not have anything to eat or drink for 4 hours prior to the examination. Oral preparation may need to be collected from Repat Radiology the day prior to the appointment. CT Scan - Head, Chest, and Other Regions Please do not have anything to eat or drink for 2 hours prior to your appointment. CT Scan - Spine, Sinuses and Facial Bones No preparation required. CT Coronary Artery Calcium Scoring Please avoid physical activity, smoking and drinks containing caffeine for 2 hours prior to your appointment. Ultrasound Scan - Upper Abdomen Please do not have anything to eat or drink for 8 hours prior to your appointment. Ultrasound Scan - Renal and Pelvis You are required to have a full bladder for this examination. Please drink 1 litre of any fluid (tea or coffee included), finishing 1 hour before your appointment time. Your Ultrasound examination will not commence without a full bladder. You may choose to arrive with a full bladder or you may arrive 1 hour prior to your appointment time and drink the litre of fluid at Repat Radiology. Ultrasound Scan - Obstetric Please drink ½ litre of fluid one hour before appointment time. Extract of Hospital Map Repat Radiology is located in the Repatriation General Hospital (RGH), on the corner of Daws and Goodwood Roads at Daw Park. It is best to enter the hospital from Daws Road and park in “The Repat Clinics” car park, from here, follow the covered walkway to Repat Radiology. It is well sign-posted. In addition there are several dedicated car parks for Radiology patients; these are located in car park 8, please refer to the map. Repat Radiology is pleased to answer your queries. Please contact us on (08) 8275 1906.
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