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Chest Pain – Rapid Access Referral
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Tas Holters
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Chest Pain – Rapid Access Referral
Zest
2026-07-23T14:18:00+10:00
Chest Pain – Rapid Access Referral
Please perform an Exercise Stress Echo for the following patient:
Chest Pain – Rapid Access Referral Form
Gender
Male
Female
Height
Between 150cm - 160cm
Between 160cm - 170cm
Between 170cm to 180cm
Between 180cm to 190cm
Weight
Underweight
Healthy weight
Overweight
Obese
Private Health Insurance
Yes
No
Please tick as appropriate:
*
Able to exercise
Currently Chest Pain Free
BMI < 35
Normal ECG
Negative Troponin
Vitals Normal
Hypertension
Diabetes
Smoker
Family Hx IHD
High Cholesterol
Peripheral Vascular Disease
Obesity
Past Hx IHD
Are you a GP or an Emergency Department doctor?
*
GP
ED
Have you email Results or ECG to reception@charlesheart.care?
*
GP
ED
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