Transfer of information form

Transfer of information form

Dr. Bryce Joynson (MBBS, FRACGP) - Robina Specialist Suites
Name

First NameLast Name
Date of Birth
DD/MM/YYYY
Date

DayMonthYear
Date
Dear Doctor,

Re: Request for transfer of patient medical records

The patient listed above has requested a transfer of clinical information to Dr. Bryce Joynson @ Robina Specialist Suites. To assist with their ongoing clinical care, please forward a copy of their medical records and any other relevant clinical information or consultation notes.

Please send records either by:
- Medical objects to Dr. Bryce Joynson (527680AK)
- Best Practice - direct transfer
- Export as XML (CTRL + F2 when in patient file) and email to info@robinaspecialistsuites.com.au
I confirm that I have understood all of the information contained in this document and consent to the transfer of my personal medical records.

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