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istory Report for:
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Printed: 27/04/2016 10:08:02 AM 
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Pritsicpt. 3tk)T,tc.iry
SU415.0411 rape 2 
Australian Cos eminent 
Patient's Details 
Surname 
Given 
Names 
Date of Birth 
Home 
address 
‘? 
Centrelink 
4 Medical Certificate 
Your persona: Information a weeded by law. Tna authority to collect the information is cantered In 
the Social Security (Admired:aeon) Act 1999. The information prodded as Ire form wet be used to decide 
correct payments and satires for you and store relevant third parties. For to purposes of referral tor 
altraCOriate assistance. CentreIrk may give your information to: Cenireink contracted assessors: the 
Department d employment and vliorkplace Reatons (DEWR) and .ico Noma menusers or Benne* 
provider! working on their behalf: to the tthpannwed of Family end Community Services (FaCS) and 
their 
funded semices to the Department of Health and Agana (DOHA) and Mew herded services; and to the 
Department of. Educaton. Science and Trailing (0ESI) and thee funded services. 
Mahal* to release medical information 
authors* Centreank to release any migrant medial irIonnaton niforiSaiy to decide my quathcation 
for 
aaewance. pension and eligibility for assistance from my doclor(s), or ocher registered medal 
p(actiioners weltr heath protesseenar *hominess consulted. co to ahem I may be referred by 
Centrernk. 
t =ISM( to Commlnk etaangag relevant nformailm about my misdeal conditals and any other 
ratan barriers impacting on my ability to tirtriPahlr in *salience Programs with my Coaling dater ) 
and any other health prolessonals I may have otitiuked. Or to who I may be referred by CorereIrk in 
Cedar la Cerltrelink to deckle correct payments and stiletto 'miens and programs for rnYiell. and 
witive relevant. third parties 
Patient Signature 
and date 
Dif.
EL--4a1.---- list all medical conditions (illness, injury or disability) which impact on your patient's capacity for work or study. 
ll 
2 
3 
This condiThin is 
Fitness for work/study 
usual 
work/study? 
Can the patient do any other work for 
8 
hours or more per week? 
s m toms of the condition) 
In order to prepare your patient for return to work/study, 
certain assistance may be offered. Please identify any 
factors which may impact on participation. 
Referral to physiotherapy for support of return to 
normal function 
Treatment - Please describe the patient's treatment 
regime. Include past, current and planned treatment. 
Certification by Medical Practitioner 
This person has been: 
4 My patient since 
,-=r, A patient of this practice since 
Doctors printed name 
Qualificatio 
ns 
20/4/2016 
20/4/2016 
Dr Ian McGiMav 
Intern 
Provider 
DO. 
5083261F 
Surgery/Medical 
Centre/Hospital name 
Street Address 
Telephone 
Doctor's signature 
Kadin Medical Center 
If this form was completed by a business with 
fewer than 20 employees. please provide an 
estimate of the time taken to complete this tom 
hours 
minutes 
EFTA00265398

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Fri 26/06/2020 5:03 PM 
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1 attachments (9 MB) 
DR JONES.tit 
Dear Dr Jones, 
,*  As requested I have attached a copy of the CT Scan referral by Dr Daehn for my appointment 
scheduled for Monday 29th June 2020, 10.45am. 
Kinc
Seids 
Virus-free. www.avg.com
Nine. 
dinah into revnhytallhitinhnyfirl/ACIAlcAllAwATMi7mVA7CliiM21 J51 TihNwhirtMDACLTAwCaAOACO%2F1NxH10aEtJoDxSXYH%2FHZI0YAD 
1/1 
EFTA00265399

PERYtryt4514T- i NJ L.) 
_ 
SO5pecra,. FRF)CrOR61::) NeCK 
PRWATS sEc. t oR 
,2o2D 
93 Kensington Road 
Norwood 5067 
P 0884315606 F0884313092 Enorwoodeproboattheare.corn.au 
Dr Susanne Davis 4. 
MBBS, FRACGP 1997 
Provider No: 224536DL 
Dr Graham Wright 
279 Payneham Road 
Suite 1 
Royston Park 5070 
Dear Graham 
Re: 
Thank 
u for seein 
aged 50 yrs, for an opinion and management. 
Past History: 
06/11/2019 
Dental caries 
Allergies:
Penicillin 
Current Medications: 
1-2 tabs qid prr 
* 
K 
CO-/I/VI isik) 
Lye 
e 
We now have Mtdical-ohjects 
which enables us to sekvrely 
oils. Please let us know If you are able to 
receive referrals this way • 
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Australian Goverment. 
tCE5OLT" 
jolZ - 
Centrelink 
Tel RC ET ( NICA 
a
$0415.0411 (Page 2 of 4) 
'cal Certificate 
Office use only
( CuS)Omer CRN 
 
Patient's Details 
Surname 
Given Names I a 
Date of Birth 
Home address 
Yak pervenal IntennatIon is protected bylaw. The wanly b abed Iris irlatmatcn is contained in the 
Wad Etechrity (AdrrAttrafon)Act 1999. The information provided on this form will be used to decide 
and payments and services la you end whore reamer. tat panics. For the purposes of 'tetanal fcr 
[template assistance Centrelink may give your information to Centrelink ccalrected assessors; the 
Department of ErnpiOyment and VVorkptace Rotations (DEWR) and Job Nthwar members or SIII1603 
Providers working on emir behalf; to Ow Department of Family and Community Services (RIGS) end lien 
funded service,; to NO Department of Heath and Ageing (lioirA) and thee horded 30CY;COS: OM 10 the 
Department of. Educkca Science and Training (OEST) and their folded services 
Authority to release medical infonnation 
. I autivrise Centrelink to reiene any relevant medical information necessary to decide my quanfrealion 
ran 
aberrance. pension and eligibility for assistance horn my dooter(s). or ONO" registered medics 
practitioners arcior health professionals whom I have consuited, or to %Morn I may be fettered by 
Centrevik. 
• I consent to Centre/ink exchanging relevant information abort my modal candalCOS and any other 
relevant banners impacting on my ability to participate in assistance programs widi my treating doctor(*) 
and arty other hearth professionals I may have consulted. or to .A10 I may be referred by Centselintr in 
order for Gentreank to diode correct payments and salable services and programs for myself, and wrare 
relevant. third parties. 
Patient Signature 
and date 
1 
o
Diansie
st all medical conditions  Illness. injury or disability) which impact on your patient's capacity for work or study. 
I
f 
2 
This c 
UNCERTAI 
Date of onset Of known) 
L 
C
uary
.
 2016  .] 
3 
Symptoms (Please list all 
' 
symptoms of the condition) 
Prognosis — Symptoms are: 
Uncertain 
Fitness for work/study 
In my opinion this person is/has been unfit for work/study 
from19/1/2016to 19/3/2016 inclusive. 
Can the patient currently do their usual 
work/study? 
No 
Can the patient do any other work for 8 
hours or more per week? 
No 
In order to prepare your patient for return to work/study, 
certain assistance may be offered. Please identify any 
factors which may impact on participation. 
Treatment - Please describe the patient's treatment 
regime. Include past, current and planned treatment. 
Certification by Medical Practitioner 
This person has been: 
My patient since 
A patient of this practice since 
Doctors printed name 
* 
 Or. A, M. IStani 
Qualifications I 
MRS, FACRRM, MOPS 
 Provider no. 
Surgery/Medical 
Centre/Hospital name 
Street Address 
Telephone 
Doctor's signature 
0982826X 
Pixie Medical Centre 
45 Gertrude Street 
Pod Pixie SA 5540, 
thierrormwarrcom e d by a business with 
fewer than 20 employees. please provide an 
estimate of the time taken to complete this form 
Malt 
newts 
EFTA00265401

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Name and PBS approval number of 
pharmacist Issuing this authorisation 
Risdon Pharmacy 
Sobia Irian Hashml B.Pharmacy 
186 Balmoral Road 
Port Pinta SA 5540 
Ph: 08 8633 4887 
03/02/2018 CH 40676W 
Date this authorisation prepared 
aro that I hare gashed hits/these meek:logs) and be Int °maim 
19 loony enntement to a phannecetnicet benefit is correct. 
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tralin Goveirreet Department of Human Sent= for the assessment and administration of paymenb and (II Z. 
3. This llganslan Is rewired to press suerapilicalion ordain. 
armatitin may be used by the deportment or ohm b ober pasta for the purposes of research, Irmestigallon . 
e you have agreed or it Is required or authorised by law. 
get more Intometion about the way In whkh the Department cf amen Senteo rill nunoge }cur personal 
bchading our privacy wig at bmneaservicesagraurnritacY Of by leilgging a copy 1mm the 
PS:O.13ln 
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Our ret 13YNFtR063 
1 May 2013 
Ms 
Dear Ms 
ment of South Australia 
Yorke 
Region 
of- Pod Pirie Regional Health Service 
The Terrace 
PO Box 546 
PORT PIRIE SA 6540 
Phone 
(08) 8638 4581 
Fax 
(08) 8536 4356 
MIN 
96 157 660 818 
Website 
syrrr healthea oov.au 
I write in response to your letter dated 23 April 2013 in which you are seeking information on the 
meetings that have occurred during the year of 2009 between you and I so you can provide this 
information to the Minister for Health. 
k  I can confirm that we have met on two occaslo 
our proposed Business Plan and 
research and that these meetings were eter on 11 De 
2009 and 5 February 2010, as 
arranged by my therWxecutive Assistant Ms Jemma Salvemini. 
I also understand that you would like inform 
e role of the Port Pine Health Advisory 
Council (HAC) and that you are considering applying to the HAC to become a member. Can I 
please suggest that you write to the HAC expressing your interest in becoming a member and ask 
that the HAC consider your nomination. The letter can be made attention to Mr Barry Hay, 
Presiding Member of the Port Pine Health Advisory Council, PO Box 546, Port Pine SA 5540. 
I will be in contact with you shortly to discuss the role and function of the HAC. 
Yours sincerely 
Kirchner 
Regional Director 
u-EmmA sAckicmiN, 
ROGER I<IRLI-WER AS5 Is-TA N1 (2009 
4 H, El DI 
SALVE 
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WestSide Lawyers 
WestSide Cornniunity Lawyers Incorporated 
REPLY TO: 
OUR REP 
g December zits - • -7:- • 
- 
Ms 
,;77, 7 Meadow Creacent 
‘155RT.,,PIRlE SA . 5540 
Dear Ms 
0 
Please read each document carefully and contact me imm€aratety itiefird you haCie any queue is 
or concerns in relation to the-content of the material. 
HIPDMARSH 
212 Port Road 
Hindrnersh 
SA 5007 
Phone:
• : 
PO PT PRIE 
%JR, ArPet 
72 Elan Street Port Pine SA 5540 
PO Box 295 Port Pine SA 5540 
Phone: 
fax 
RE: 
Refuse Breath Test 
I write to you in relation to the above matter On the 7 December 2015 I received scrne disclosure 
from Prosecution in relation to this matter_ I now enclose a copy of the following .6cuments for 
your information (see attached): 
o 
Statement of Officer Kathy Jacobs 
c 
Notes of Officer Kelly 
Statement of Officer Scott Kelly 
o 
Oral Advice on Refusei?eath Test 
I can advise that if you wish to contest the allegations then I will need to obtain further details from 
you such as: 
How did you get onto John Mile island?. 
3.1 2. Who is the owner of the maroon car? 
3. Were you sitting in the marten car when police approached you?; and 
4. Where was the driver of the vehicle when you were approached by police? 
After you provide answers to these questions I will be in a better position to advise you as to 
whether or not Prosecution will be able to successfully prosecute you In relation to these charges. 
Your next court hearing is the 12 January 2016 at 1.0:3o am In the Port Ririe Magistrates Court. 
I can advise that I will be on leave from the 14 December 2015 until the 4 Jar.uary 2016. Please 
contact me sometime shortly after I return to work with further instructions. 
.• 
Yodrs faithfanw 
WESTSIDE LAWYERS 
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Ph: 08 8633 4887 
03/02/2016 CH 40676W 
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