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Discipline

: General

Sub Discipline

: General

Document Title

: Cardiology Referral Letter

REASON FOR REFERRAL

Ethnic Group

Referring Speciality

MEDICAL HISTORY

Reason Of Admission

Type Of Admission

Elective

Casualty / Emergency / Others

Comorbidities

Hypertension

Diabetes Mellitus

Dislipidemia

H/O MI

Family h/o CAD

H/O or current arrhythmias (AF etc)

Current angina pectoris

Documented CAD > 50% stenosis

Heart failure

Chroniclung disease (COAD etc)

Renal disease

Cerebrovascular Disease

Peripheral Vascular Disease

Others, specify

DETAILS OF REFERRAL

Reason For Referral

Assess perioperative cardivascular risks

Acute coronary sysndrome

Request for echocardiography

Suspected infective endocarditis

Assessment of arrhythmias

Decompensate heart failure / APO

INR adjustment

Request for angiogram / angioplasty

Others, specify

Ecg / Est

Echocardiogram

Msct / Mri / Other Imaging

Lab Investigations

Diagnosis

Medications

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