FOR OUR REFERRING DOCTORS

Our clinic provides initial consultations, ongoing care and management for patients who have the entire spectrum of cardiac conditions.  We also provide the care for primary and secondary prevention for cardiac diseases.

The diagnostic services that we provide include 12-lead ECG, 24 hr/48 hr/72 hr/7day/14 day holters, loop event monitor and 24 hr/48 hr ambulatory blood pressure monitor. We also provide exercise treadmill test, bicycle stress test for patients who have difficulty with the standard treadmill test. In addition, we provide transthoracic echocardiography and stress echocardiogram. The stress echo is either done by treadmill or by bicycle protocol.

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    PATIENT INFORMATION

    MaleFemale

    HEALTH #:

    VERSION CODE:

    DATE OF BIRTH:

    APPOINTMENT DATE:

    APPOINTMENT TIME:

    CARDIOLOGY CONSULTATION:

    REASON:

    CARDIOLOGY PROCEDURES:

    ECHOCARDIOGRAMSTRESS ECHOSTRESS TESTECG24 HRS. HOLTER MONITOR48 HRS. HOLTER MONITOR72 HRS. HOLTER MONITOR14 DAY HOLTER MONITORLOOP EVENT RECORDER24 HRS. AMBULATORY BPMONITOR ($75)IF ABNORMAL PLEASE ARRANGE CONSULTATION

    CARDIAC PREVENTION & REHABILITATION (HOME BASED) Canadian Cardiac Network indications:

     ONE OF THE FOLLOWING:

    AT LEAST THREE OF THE FOLLOWING:

    CADMICABGPCITIAAF/AFLVALVE SURGERYDIABETESVASCULAR DISEASECVATIACVA

    HYPERLIPIDEMIAHTNFAMILY HISTORYSMOKER

    CLINICAL INFORMATION

    REFERRING MD:

    MD BILLING #:

    MD SIGNITURE:

    DATE:

    CALL MY OFFICE WITH APPOINTMENT