Peninsula Lung Function Laboratory
Peninsula Private Hospital, Consulting Suite 14, Building 2 525 McClelland Drive, Langwarrin, Victoria 3910
Booking: (03) 8905 3737 Fax: (03) 8907 8386 Email: admin@lungcarevictoria.com.au

Patient Details: (Bradma)
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Referring Doctor: (Stamp)
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Clinical Notes:

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

Tests:
 Spirometry – Pre & Post Bronchodilator*  Diffusing Capacity / Transfer factor*
 FeNO (Fractional exhaled nitric oxide)
 Bronchial Provocation Challenge 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: ..................................................................................................
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Service Providers:
Dr Amanuel Tesfai, Dr Amir Zangiabadi, Dr Yee Tung (Eric) Kuo