Calvary Cardiac Centre
49 Augusta Rd Lenah Valley 7008
Weekdays 8.00am to 5.00pm
Ph: (03) 6279 5700
FAX: (03) 6278 9221
Email: TAS-LVH-CardiacCentre@calvarycare.org.au
We also accept referral via Healthlink EDI CHCTLVCS

Patient Details	Referring Doctor	
<PtFullName>
<PtAddress>
PH: (W) <PtPhoneWk>   (H) <PtPhoneH>
Mob: <PtPhoneMob>
DOB: <PtDoB>  Gender: <PtSex>
Medicare: <PtMCNo>	<DrName>
Prov: <DrProviderNo>
<DrDetails>
Ph: <DrPhone>
Fax: <DrFax>	

Requesting Dr Signature: 
	Date: <TodaysDate>	

Clinical Details	
<Clinical details>

Examination Requested		
1. ECG  <ECG>	6. Stress Echocardiogram  <Stress Echocardiogram>	
2. 24 hour Blood Pressure Monitor  <24 hour Blood Pressure Monitor>	7. Consultation <Consultation>	
3. Exercise Test (Treadmill)  <Exercise Test (Treadmill)>	8. Heartbug  <Heartbug>	
4. Echocardiogram  <Echocardiogram>	9. Chest Pain Evaluation Clinic  <Chest Pain Evaluation Clinic>	
5. 24 Hour Holter Monitoring  <24 Hour Holter Monitoring>		
Your GP may be able to provide you with an information sheet on the examination you will be having.

Appointment Details	
Date:  	
Time:  	
Calvary Cardiac Centre
49 Augusta Road Lenah Valley Tasmania 7008 Australia
(Please follow the signs from the Main Foyer of Calvary Hospital)	
Where is the Calvary Cardiac Centre located ?	
The Calvary Cardiac centre is located on the Lower Ground Floor of Calvary Hospital
 situated within the Calvary Medical Centre.	
Parking is available on the western approach of the hospital (off Augusta Road)