Holmesglen Lung Function Laboratory
Holmesglen Private Hospital, Consulting Suite D1
Ground Floor, Building 2, 490 South Road, Moorabbin 3189
Booking: (03) 9567 9081 Fax: (03) 9567 9079 Email: admin@lungcarevictoria.com.au

Patient Details: (Bradma)
Name:  .................................................................................................
DOB: ..................................... Contact No: .....................................
Address: ..............................................................................................
...............................................................................................................
Referring Doctor: (Stamp)
Name:  .................................................................................................
Address: ..............................................................................................
...............................................................................................................
Provider No: ......................................................................................
Date: ..................................... Signature: ........................................
Clinical Notes:

Test Appt: ............................... Doctor Appt: ..................................

Tests:
Spirometry – Pre & Post Bronchodilator*
Diffusing Capacity / Transfer factor*
Lung Volumes (Body plethysmography)
FeNO (Fractional exhaled nitric oxide)
Maximal Inspiratory & Expiratory Muscle Pressures
Bronchial Provocation Challenge Test**
Lung Volume Reduction Assessment**
High Altitude Simulation Test**
No breathing medication on the day of testing.
No smoking on the day of testing.
** Requires prior discussion with service providers.
Send Results Via:
Argus: ..................................................................................................
Phone No: ................................... Fax No: ......................................
Email: ..................................................................................................
Service Providers:
Dr Amanuel Tesfai, Dr Amir Zangiabadi, Dr Yee Tung (Eric) Kuo

Route to Suite D1
490 South Road, Moorabbin 3189 Melway Reference: Map 77 G5

Fletcher Street

Doctor Carpark

No Entry

AU2DIT-

GYM

Loading Bay

24H

Overpass

SUITE D1

ORIUM

CAFE

X-RAY

1

2H

$	RECEPTION
PATHOLOGY

AV
ED  Entry

24H

ED Entrance

$

$

Main Entrance

24H

24H

 Information Point  Holmesglen Security  Parking Available

$

 Disabled Parking Ticket Machine Bus Stop
Route to Suite D1

4

South Road

South Road

Building 1
Holmesglen Private Hospital
Building 2
Consulting Suites
Building 3
Holmesglen Institute

Car Parking
Teal Zone: $4 for 2 hours
Blue Zone: $6 for 24 hours

Disclaimer: The information contained in this publication was accurate at the time of printing and is subject to change without notice. It is recommended that information be verified prior to being acted upon. 2019