•	Reason for referral, expectations and needs (including the problem to be assessed, degree of loss of function, pain experienced)
•	Patient demographics including Medicare number, interpreter requirements and mobile phone contact number
•	Patient's mobile phone contact number and an alternative postal or contact address (if not the same as usual residence)
•	Presenting symptoms/observation (including evolution and duration, severity, impact of condition)
•	Physical findings
•	Co morbidities (including Diabetes, cardiopulmonary, renal, obesity, (BMI) and details of any associated medical conditions which may affect the condition or its treatment
•	Results of relevant investigations (pathology, radiology, histology)
•	Current medications and doses, prescribed and over the counter (note any recent changes in drug therapy)
•	Relevant information about the patient's condition such as previous medical/surgical treatment (include systemic and topical medications prescribed for the condition)
•	Relevant psychological and social issues including impact on:
o	Employment;
o	Education;
o	Home;
o	Activities of daily living – low/medium/high
•	Alerts (including Rx [sp anticoagulants, immunosuppressive], Allergies (drug/topical preparation)
•	Smoking, alcohol history, substance abuse

Rockhampton Hospital - Antenatal Clinic

Rockhampton Hospital - Gynaecology Services

Capricorn Coast Hospital And Health Service - Neonatology & Perinatology

Gladstone Hospital - Obstetrics

Gladstone Hospital - Gynaecology Outpatient Clinic

Biloela Hospital - Antenatal Services

Woorabinda MPHS - Antenatal and Post-natal Clinic

Monto Hospital - Antenatal Clinic

Dysart Hospital - Antenatal and Post Natal Clinic

Bundaberg Hospital - Gynaecology Clinic

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Obstetrics and gynaecology in Rockhampton

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Rockhampton Hospital - Antenatal Clinic