GEORGE TOWN MEDICAL CENTRE PTY. LTD.
A.C.N. 009540 676
Dr TIM MOONEY
MB BS(Tas ) FRACGP
Dr BRIAN BOWRING
MB BS (Tas) FRACGP,DRANZCOG, FACRRM
Dr PHILIP DAWSON
MMBS (Monash) FRACGP,DRANZCOG
Assoc:
Dr JANE ZIMMERMAN MD
Dr. JANE ZIMMERMAN MD
Dr. BRONWYN HARON MBBS (QLD)
Dr. ADAM RENWICK MBBS B.ExSci FRACGP
Dr. IKECHI GBENIMACHO MBBS (Nigeria
To………………………………
49 Anne Street
George Town Tas. 7253
PO Box 163
George Town Tas. 7253
TELEPHONE (03) 63824333
ALL HOURS
FACSIMILE (03)63823535
Date: …………………………..
…………………………………
…………………………………
Dear Doctor,
This document is an authority for the following patient’s clinical records to be forwarded to our
practice.
Re:…………………………………………….D.O.B…………………………….
Patient Signature…………………………………………………………………
Re:……………………………………………..D.O.B…………………………….
Patient Signature …………………………………………………………………
Children
………………………………………………..D.O.B…………………………….
………………………………………………..D.O.B…………………………….
………………………………………………..D.O.B…………………………….
The above-named patient/family have indicated that they wish to attend this practice on a regular
basis. Would you please provide medical information to assist us in providing ongoing medical
care?
If you are using Medical Director could you please download onto a CD-ROM.
George Town Medical Centre would be grateful if you could also fill out the table on the reverse.
Yours faithfully,
The Doctors at George Town Medical Centre
Item
Diabetes (Item 2517, 2521 etc)
Health Assessment (Item 701,
703, 705, 707, 715))
GPMP (Item 721)
Team Care Arrangement (Item
723)
Review of GPMP/Team Care
(Item 732)
Mental Health Care Plan (Item
2710, 2702)
Review Mental Health CP (Item
2712)
Date last Claimed
Never claimed
(please tick if never
claimed)