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{"status": "completed", "conte {"status": "completed", "content": "Please fax recent lab\n invesgaons, including Lipids,\nECG and Medica on List.\n \nDate:_________________________________________\nPhysician name:_________________________________\nPhysician address:_______________________________\nPhysician number:_______________________________\nPhysician signature:______________________________\nConsidered a valid prescripon when signed by a physician\nCopies to:_____________________________________ _\n250, 8500 Blackfoot Trail SE\nCalgary, AB T1Y 0B4\nT 403.879.7911\nF 403.879.7899\n201, 3151 27thStreet NE \nCalgary, AB T1Y 0B4\nT 403.235.4109 \nF 403.235.4147\nInternal Medicine\nEndocrinology\n\u2751Geriatric Medicine\nPaent Informaon Referring Physician\nConsultaon Requested:\n\u2751Cardiology\n\u2751\n\u2751\nMD, FCCP Internal Medicine\nMD, FACP Internal Medicine\nMD, FRCPC Cardiologist\nDr. Ravi Varshney\nDr. Lovpreet Mangat\nMD, FRCPC Internal Medicine\nDr. Faisal Hasan\nMD, MRCP Endocrinologist\n\u2751\n\u2751\n\u2751\nDr. Anmol Kapoor\nMD FRCPC Cardiologist\nDr. Alvin Villanueva\nDr. Ali Debek\n\u2751\n\u2751\n\u2751\nConsult\nUrgent (within 2 weeks) Semi-Urgent (more than 2 weeks) Phone Consult \u2013 Call 403.235.4109 to request\u2751 \u2751\u2751 \u2751ASAP\nPaent Like hood of CAD:\n \n(Plaque presence, caro d inmal medial thickness)\n) \nStroke / TIA\nFollow-up of known carod stenosis\nfollow-up\nPCOS\nHypo / Hyper Thyroid\nHirsusm/Amenorrhoea\nAdrenal Disorder\nAbnormal ECG\nPost PCI\nAbnormal Treadmill Stress Test\nMurmur\nShortness of breath\nHypertension / Le ventricular Hypertrophy\nPulmonary HypertensionIntermediate High\nCardiac Diagnosc Examinaon\nMyocardial Perfusion Imaging\n(MPI\n\u2751\n\u2751\n\u2751\n\u2751\n\u2751\n\u2751\n\u2751\n\u2751\n\u2751\n\u2751\n\u2751\n\u2751\n\u2751\n\u2751\nExercise MPI\u2751\n\u2751Pharmacological MPI\nDoes Your Paent Have:\nMedicaon:\nCAD / CHF\nF/U Known Stable CAD\nFunconal Significance Coronary Stenosis\nChest Pain\nPalpitaons / Arrhythmias \n(suspected/known history of arrhythmia)\nEdema / PND / Orthopnea\nCardiovascular risk assessment\nSyncope / Presyncope / Vergo / Dizziness\nCarod Bruit\nPost-surgical angiographic intervenon \nLow Testosterone\nYoung Type 2 Diabetes\nPituitary Disorder\n\u2751\n\u2751\n\u2751\n\u2751\n\u2751\n\u2751\n\u2751\n\u2751\n\u2751\n\u2751\n\u2751\n Please Check all that apply:Indicaons:\n(Includes Cardiology Consult)\n\u2751\n\u2751 Diabetes Type 2/Complex\n\u2751\n\u2751\n\u2751\n\u2751\n\u2751\n\u2751\nBubble Echocardiogram\n(Includes Cardiology consult)\nEchocardiogram \nCarod ultrasound\nExercise Stress Test\n(Includes Cardiology Consult)\n24 Hour Holter Monitor\n\u275148 Hour Holter Monitor\n5 day Holter Monitor\n\u2751ECG \u2013 Electrocardiogram\n24 hour BP Monitor\n\u2751ABI (Ankle Brachial Index)\n\u2751\nLow\n.\nwww.advancedcardiology.caPlease fax completed form - we will call the paent to book\nClinical Notes:\n \nHeight___cm/in Weight___lb/kg \nYes No\nNo\nNo\nNo\nNo\nYes\nYes\nYes\nYes\nDiabetes\nAsthma\nPacemaker\nICD\nCABG\nUrgency\nReferral\n\u2751Stress Echocardiogram\n(Includes Cardiology Consult)\nhello doctors\nTesting\nABCD EDF\n, , , \n28-06-2025\nDiv Kash Kash\n, , , AB\n21-12-2000\n\u2714\nnejfne fejnfwe"}... |