Acclario Plum 1.5 Test Deploy Testing eConsult Plum 1.5 Test Deploy 2 Testing General Practitioner InformationGP Name* First Last GP provider no. HiddenPosition seeking advice GP Contact NumberGP Email* Practice InformationPractice Name Practice Address Street Address Suburb State Postcode Patient InformationPatient Name* First Last Patient URN Patient Sex* Male Female Indeterminate Patient Date of Birth* DD slash MM slash YYYY HiddenTime : Hours Minutes Patient Contact Number*Patient Address* Street Address Suburb State Postcode QuestionHiddenCategoryDiabetesEndocrineWhat is your Clinical Question?*Please do not provide any patient identifiable information in this section (e.g. first/last name, date of birth, address) Consent for photos obtained from patient or substitute decision maker?Consent is required if you are attaching photos Yes No Photos and Additional Documents (1000MB maximum file size. If uploading multiple photos and documents, make sure that file names are different) Drop files here or Select files Accepted file types: jpg, jpeg, gif, png, pdf, docx, rtf, xlsx, Max. file size: 1,000 MB. Consent* I can confirm that I have obtained patient consent for this service and have advised the patient that a medical record will be created for them at the Princess Alexandra Hospital if one currently does not exist.