Aged Care Booking Form – Sydmed

Do we provide after hours cover in your area?

X

Online booking now

Requests via Aged Care Bookings can now be submitted at any time.
However, staff will confirm when the call centre opens if doctor is available.

Doctor Consultation for Aged Care Facilities

AGED CARE FACILITY

Name of RACF/HOSTEL/GROUP HOME:
Address:
After hour contact number/instructions:
Door / Gate codes:
Name of RN for visit
Contact Number:
Contact Email:

FIRST PATIENT

Full Name:
DOB:
Gender:
Patients General Practitioner :
Patients General Practitioner Number:
Patients/GP Medical Centre:
Medicare Number :
Ref:
DVA Gold Card number :
Level/Ward/Section :
Complaint / symptoms for doctors visit:
Allergies:
Special Patient Instructions:
If "Yes", please have these available on arrival.
Next of Kin Name :
Next of Kin Phone:

SECOND PATIENT

Full Name:
DOB:
Gender:
Patients General Practitioner :
Patients General Practitioner Number:
Patients/GP Medical Centre:
Medicare Number :
Ref:
DVA Gold Card number :
Level/Ward/Section :
Complaint / symptoms for doctors visit:
Allergies:
Special Patient Instructions:
If "Yes", please have these available on arrival.
Next of Kin Name :
Next of Kin Phone:

THIRD PATIENT

Full Name:
DOB:
Gender:
Patients General Practitioner :
Patients General Practitioner Number:
Patients/GP Medical Centre:
Medicare Number :
Ref:
DVA Gold Card number :
Level/Ward/Section :
Complaint / symptoms for doctors visit:
Allergies:
Special Patient Instructions:
If "Yes", please have these available on arrival.
Next of Kin Name :
Next of Kin Phone:

FOURTH PATIENT

Full Name:
DOB:
Gender:
Patients General Practitioner :
Patients General Practitioner Number:
Patients/GP Medical Centre:
Medicare Number :
Ref:
DVA Gold Card number :
Level/Ward/Section :
Complaint / symptoms for doctors visit:
Allergies:
Special Patient Instructions:
If "Yes", please have these available on arrival.
Next of Kin Name :
Next of Kin Phone:

MEDICAL EMERGENCIES REQUIRE IMMEDIATE MEDICAL ATTENTION REFER TO 000

Hours of operation:

Monday to Friday from 6pm to 6am

Saturday from 12pm

Sunday and Public Holidays 24 hours

FREQUENTLY ASKED QUESTIONS

About Sydmed Doctor Visits

IMPORTANT PATIENT INFORMATION

Download Multilingual Brochures

IMPORTANT DOCTOR INFORMATION

Download our Doctor Information Sheet

VIDEO CONSULTS INFORMATION

View Instructions