For Doctorsncsc2025-06-03T00:19:05+00:00 For Doctors Call: 08 8250 9050 Email: cardiology@ncsc.com.au Fax: 08 8281 2511 Heathlink ID: northcar Please fill out the online referral form or download the PDF version below and return to us. Download Referral Form Patient Details Name First Name Last name Address Street address Suburb Postcode Date of Birth Medicare No. Reference number Expiry Telephone Home Telephone Mobile Referral Details Consult/ Investigations Requested Clinical Details Referring Doctor Referring Dr Name DrDr.MissMr.Mrs.Ms.Prof.Rev. Prefix First Last Address Street address Suburb Postcode Provider No. Results Fax: Email: Copies to: Doctor's Signature Date Investigations Performed at Northern Cardiology 12 lead resting ECG Transthoracic Echocardiogram Initial echocardiogram Frequent echocardiogram request for GPs Valvular dysfunction Structural / heart failure Rare conditions Frequent echo Exercise Stress Echocardiogram (with consultation) Exercise Stress Test (with consultation) Cardiac Internal Electronic Device Interrogation (with consultation) Ambulatory ECG (Holter) monitoring 24 hours 3 days 5 days Ambulatory 24 hour BP monitoring Cardiology Consult RequestNorthern Cardiology Dr Margaret ArstallDr Sujith ChackoDr York Yann Chow [Stress Echos Only]Dr Dimitrios LypourlisDr Gnanadevan Mahadavan [Consults & Stress Echos]Dr Rajiv MahajanDr Varun MalikDr Kumaril MishraDr Mohammad Omair [Consults & Stress Echos]Dr Gao OngDr Purendra PatiDr Ivan StraznickyGawler ClinicDr Mithun Varghese [Consults & Stress Echos]Dr Sujith ChackoDr Andien MunawarKapunda ClinicDr Kumaril MishraPort Pirie ClinicA/ Prof Margaret Arstall (Cardiac Device Clinic)Dr Kumaril Mishra (consultation) Upload a Copy of Your Referral