GENERAL INFORMATION
|
| Name: .............................. |
Medical Record
Number: ............ |
| Date of birth:
................................. |
Tel: ............................................. |
| Occupation:
.................................. |
Mobile: ....................................... |
| |
|
| Asthma
Centre: (02) 9515 8613 |
|
E11 South, RPAH
Camperdown,
2050
|
Specialist
doctor: ......................... |
| |
Specialist
Tel: .............................. |
Open
Wednesdays ONLY
Please give 24 hours notice of cancellation |
| |
|
| Local doctor: ............................... |
Address:
...................................... |
| |
Tel: .............................................. |
AMBULANCE 000
|