yutraen Government centrelink Medical Certificate ($U415) Centrelink customer: dt you knw? You can locye ths certificate with us using Online Services or one of our Exprass Plus Amps. Go to servicesaustralla.gov.au/subsnitdocumentsonline Patient's details can 2,06 |-|1,0,5 - 0 8 2|-[L| Famly name [ LYNN Home aittess [ aaa OXFORD STREET Firstname =| SAMANTHA PADDINGTON Seeandname | JEAN Postode 2021 Deteotith [22 7 06 / 1974 | ‘Ths persontas veen: My pattntsince| 03 ¢ 07 / 2017 ooo Diagnosis — List tne main merical conditions which impact an the patents capacity to work or study (Primary constion sheuid be the condtion wth the most Impact BRONCHIOLITIS/PLEURAL EFFUSION A patient ofthis practice since Secondary/Related condition(s) 03 / 07 / 2017 HUMAN METAPNEUMOVIRUS, Date of onset «known | 12/ 08 / 2020 Date of onset (t known) 12/08 ¢ 2020 eis confon —Tick ono ony Temporary X] Pemanent [| Temporary exacrtation [I lee to pert for ct temanent concen 2 years or mote) Ts condi —TEK oe a Teng [) femanet[] Tengu exertton OT ay aremean ) every spent C) Sead) Lessthan'monits [| 18-24montrs _] Uncertain [X]] 212 months [Mare than 24 montis |] Prognosis — Estimate how log the sjrpiomvs wil affect he patents copaoty to work or sty. Lessthan’ months |] 18-24 montis __) Uncertain (XI 3-12 months |_| More than 24 months | ‘Symptoms — List curent symptoms for each contition. (CHEST PAIN, ORY NONPRODUCTIVE COUGH, DYSPNEA ORTHOPNEA Treatment — Deserne the patient's treatment regime, inciucing past, Past: 1046 ZANAMINIF BID BY ORAL INHALATION Curren: 500M LEVOFLOXACIN PO ONGE/DALY 14 DAYS. Planned, FURTHER RAPID ANTIGEN/SEROLOGIC TESTING REGUIFED Give cetals of any other macical candtions wen impact on the pallent’s capacity to work or sty, Capacity to work or study ln my opinion the patent irhas been unfit for werkstusy trom [427 08 7 2020] tol 12/ 117 2020 |, curtent and plannesitreatment Past: 4006 MOXIFLOXAGIN PO ONCE DAILY/I0 DAYS, Current: 800M6 LEVOFLOXAGIN PO ONCE/DAILY 14 DAYS Planéd FURTHER RAPID ANTIGEN/SEROLOGIC TESTING REQUIRED Certification by Medical Practitioner Doctor's name (printed) DR JEFFREY JOHN POST Guatficalions) vanseeece pro | Provider no, 452630H Surgery/Medical contre Hpi sane SPECIALIST MEDICAL ASSOCIATES UNSW Address SUITE 14 LEVEL 7 PRINCE OF WALES PRIVATE HOSPITAL BARKER STREET RANDWICK Postcode 2031 Can the patent do any othe werk for 8 nous or mre per WaDK? ws] Nolx! ‘In order to prepare your patient for return to work or study, certain: assistance may De ofleed, identity any factors which may impact on pattcpation, umber, (02) 9982 3405, Date’ 037 10 7 2020 HACKING DRY COUGH FOLLOWED BY SHORTNESS OF BREATH, [RESTRICTION OF AIRWAYS REQUIRING NEBULISER THERAPY. seis 08