Invoice Ophthalmologist in Australia Melbourne –Free Word Template Download with AI
Level 4, 123 Collins Street
Melbourne, VIC 3000
Australia
Phone: +61 3 9000 1234
Email: [email protected]
ABN: 12 345 678 901
Invoice
Invoice Number: INV-2023-8942
Date Issued: 24 October 2023
Due Date: 24 November 2023
Payment Status: Pending
Bill To (Patient)
Mr. James Anderson
45 Chapel Street
South Yarra, VIC 3141
Melbourne, Australia
Phone: 0412 345 678
Email: [email protected]
Dr. Sarah Jenkins, FRANZCO
Specialist Ophthalmologist
Medical Practitioner Board of Australia
Provider Number: 1234567890
Medicare Provider Number: 987654321
The following Invoice details the professional fees charged by the Ophthalmologist for the comprehensive eye examination and subsequent treatment plan provided in Melbourne, Australia. These services adhere to the strict clinical standards expected of specialist medical practitioners within the Australian healthcare system.
| Item | Description of Service | Medicare Item No. | MBS Schedule Fee | Total (AUD) |
|---|---|---|---|---|
| 1 |
Comprehensive Ophthalmic Examination Detailed assessment of visual acuity, refraction, and ocular health. This consultation includes a slit-lamp examination and dilated fundus examination to assess the retina and optic nerve. Performed by a Specialist Ophthalmologist in Melbourne. |
30100 | $115.00 | $115.00 |
| 2 |
Optical Coherence Tomography (OCT) Advanced imaging of the retina to detect early signs of macular degeneration or glaucoma. This non-invasive diagnostic procedure is essential for accurate diagnosis in Australian clinical practice. |
73310 | $85.50 | $85.50 |
| 3 |
Glaucoma Assessment Tonometry (eye pressure measurement) and visual field testing analysis. Critical for monitoring intraocular pressure and preventing vision loss. |
30101 | $95.00 | $95.00 |
| 4 |
Prescription for Corrective Lenses Provision of a detailed prescription for spectacles based on the refraction results obtained during the consultation. |
N/A | $0.00 | $0.00 |
As per the regulations in Australia, the patient is eligible for a Medicare rebate for the services provided by the Ophthalmologist. The amounts below reflect the standard Medicare Benefits Schedule (MBS) fees applicable in Melbourne.
| Subtotal (Total MBS Fees) | $295.50 |
| Medicare Rebate (85% of MBS) | - $251.18 |
| Gap Fee (Out of Pocket) | $0.00 |
| Total Amount Payable by Patient | $44.32 |
Payment is due within 30 days of the date of this Invoice. Please make all payments in Australian Dollars (AUD).
Bank Transfer Details:
Bank Name: National Australia Bank (NAB)
Branch: Melbourne Central
BSB: 082-001
Account Number: 1234 5678
Account Name: Melbourne Vision Specialists Pty Ltd
Reference: INV-2023-8942
Terms and Conditions
- Accuracy of Information: The patient confirms that the personal details and Medicare card information provided are accurate. Melbourne Vision Specialists is not liable for delays in rebates caused by incorrect patient data.
- Medicare Eligibility: The Medicare rebate is calculated based on the current Medicare Benefits Schedule (MBS) rates effective in Australia at the time of service. If the patient is not eligible for Medicare, the full fee of $295.50 is payable.
- Privacy Policy: In accordance with the Privacy Act 1988 (Cth) and the Australian Privacy Principles, all patient records and financial data held by this Ophthalmologist are kept strictly confidential and secure.
- Disputes: Any disputes regarding this Invoice must be raised in writing within 14 days of receipt. Melbourne Vision Specialists is committed to resolving billing inquiries promptly and fairly.
- Professional Standards: All services rendered by Dr. Sarah Jenkins are performed in accordance with the guidelines set by the Royal Australian and New Zealand College of Ophthalmologists (RANZCO).
Authorized By:
Dr. Sarah JenkinsLead Ophthalmologist
Patient Acknowledgement:
Patient SignatureDate ⬇️ Download as DOCX Edit online as DOCX
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