Dear Doctor (please specify Staff Specialist by name):

This referral is:	q	URGENT	q	NON-URGENT	
Referral Duration	q 12 Months	q Indefinite	

Name:	<<Patient Demographics:Full Name>>	D.O.B:	<<Patient Demographics:DOB>>	
Address:	<<Patient Demographics:Full Address>>	
Telephone:	(H)<<Patient Demographics:Phone (Home)>>	(M)<<Patient Demographics:Phone (Mobile)>>	(W)<<Patient Demographics:Phone (Work)>>	
Does patient require an interpreter:	q Yes	q No	Language spoken:	
Indigenous Status	q  Aboriginal	q	Torres Strait Islander	

Referral For:	
q Gynaecology	q Colposcopy/Vulvoscopy	q Hysteroscopy	
q Abnormal Bleeding	q Prolapse	q Infertility	
Details of Referral	

	

	

	

	
Please ensure a copy of all pathology and imaging results are sent with the patient.

Referring Doctors Signature

Date:	/	/

	Referring Doctors Stamp incl Provider No.	

Gynaecology Staff Specialists – JHH / Belmont / Maitland Gynaecology Outpatient Service

Please Note:

1.   The following is a list of Gynaecologists providing specialist care in JHH / Belmont / Maitland
Gynaecology clinics. Please use this list as a guide for referral.
2.   This is for your information only and is  NOT a tick list. Please address the above referral, in the space provided, to one of the clinicians on the list
3.   Referrals should be addressed to a Gynaecologist at the hospital closest to your patient’s home.
Referrals may also be redirected to another facility to allow patients to be scheduled for a consultation in the shortest possible time.

General Gynaecology	Colposcopy	
Dr John Bailey	John Hunter	Dr John Bailey	John Hunter	
Dr Tania Day (vulvoscopy only)	John Hunter	Dr Tania Day	John Hunter	
Dr Mohamed Galal(Abn Bleeding)	John Hunter	Dr Matthew Holland	John Hunter	
Dr Matthew Holland	John Hunter	Dr Ken Jaaback	John Hunter	
Dr Lakshmi Kasi	John Hunter / Belmont	Dr Lakshmi Kasi	John Hunter	
Dr Brett Locker	John Hunter	Dr Pravin Nahar	John Hunter	
Dr Seshu Mandapati	John Hunter	Dr Sharyn Rayner	John Hunter	
Dr Pravin Nahar	John Hunter	Dr Nandini Somanathan	John Hunter	
Dr Sharyn Rayner	John Hunter	Prof Ian Symonds	John Hunter	
Dr Nandini Somanathan	John Hunter	Dr Jonathan Kew	Maitland	
Prof Ian Symonds	John Hunter	Dr Sneha Joshie	Maitland	
Dr Sneha Joshi	Maitland			
Dr Jonathan Kew	Maitland			
Dr Azra Naseem	Maitland			
Dr Alison Porteous	Maitland			
Prolapse – Urogynaecology	Infertility	
Dr Brett Locker	John Hunter	Dr Myvanwy McIlveen	John Hunter	
Dr Jane Manning	John Hunter			
Dr Sneha Joshi	Maitland			
Dr Jonathon Kew	Maitland			

Completed referrals should be faxed to:

John Hunter	Maitland	
49223905	49223909	
Referrals will be processed, triaged and a clinically appropriate appointment will be made and sent to your
patient.