eConsultation Request for Specialist Advice - General Medical

<Practice>
<UsrAddress>

<TodaysDate>

GE4101000K0
eConsultant General Physician
Dr Narelle Fagermo  
Internal Medicine, Mater Health Services
Raymond Terrace
South Brisbane Qld 4101

Re: <PtFullName>  DOB: <PtDoB>
<PtPOAddress> <PtPOCity> <PtState> <PtPOPostcode>

Dear Dr Fagermo

Thank you for the opportunity to seek your opinion / advice regarding <PtPrefName> <PtSurname>

<HisHer> currrent medications are: <CurrentRx>

Allergies: <Reactions>

Past Medical History: <PMHActive>

Investigations:<Ix>

Reason for seeking opinion and management:

Question 1. <Question 1.>

Question 2. <Question 2.>

Yours Sincerely 

<DrDetails><DrProviderNo><DrAddress>