Title: Microsoft Word - QVD Template for Medical Director
Author: user
Last saved by: Karma Hodgson

** Denotes Fasting Study

Arterial Duplex Scanning

1.1	CAROTID
2	** AAA/EVAR F/UP SURVEILLANCE
3	**AORTOILIAC
4	LOWER EXTREMITY
5	GRAFT SURVEILLANCE
6	**RENAL
7	** MESENTERIC
8	UPPER LIMB
9	AV FISTULA
10	RESTING DOPPLER PRESSURES AND WAVEFORMS
11	CLAUDICATION EXERCISE TEST

Venous Duplex Scanning

12.	12INSUFFICIENCY VARICOSE VEINS
13.	VENOUS
THROMBOSIS
14.	**OVARIAN PELVIC
15.	PERFORATOR MARKING
16.	VEIN CONDUIT MAPPING
17.	UPPER LIMBS
18.	THORACIC OUTLET SYNDROME
19.	POP. ENTRAPMENT
20.	OTHER STUDY

PHONE (all sites): 07 3350-6980
CHERMSIDE
Suite 6, Level 3, Orange Lift
St Vincent’s Private Hospital
627 Rode Road

NORTH LAKES
Room 4, Serviced Offices
Cnr Memorial & Discovery Dve
CLEVELAND
Suite 22, Cleveland House Cnr Queen & Bloomfield Sts

UPPER MT GRAVATT
CMINS rooms
Level 3, Mt Gravatt-Capalaba Road

TARINGA
Suite 2, IGH rooms, 
Taringa Central
165 Moggill Road

QUEENSLAND VASCULAR DIAGNOSTICS PTY LTD
ABN: 65 064 438 419
www.qvd.com.au Email: qvd@qvd.com.au
PATIENT DETAILS

Name: DOB:
Address:

STUDY REQUIRED

CLINICAL DETAILS

REFERRING DOCTOR DETAILS

Name:	Provider No:

Address:

Signature:

Please   Fax / Email / Mail results	Date:

P:	F:	E:
🡲 FOR FURTHER INFORMATION AND EXAMPLES OF WORKSHEETS PROVIDED GO TO www.qvd.com.au
≈ This referral carries no obligation and you may attend an imaging provider of your choice.