Invoice Psychiatrist in Australia Melbourne –Free Word Template Download with AI
Victoria Private Psychiatry Clinic
Level 4, 120 Collins Street
Melbourne, VIC 3000
Australia
Phone: +61 3 9000 1234
Email: [email protected]
ABN: 12 345 678 901
Medicare Provider Number: 987654321
45 Chapel Street
South Yarra, VIC 3141
Melbourne, Australia
Medicare Card Number: 1234 5678 9012
Private Health Fund: Bupa Private Health
Member ID: BUP-99887766
Important Notes Regarding This Invoice:
This invoice reflects the professional fees charged by Dr. Eleanor Vance, a registered Psychiatrist practicing in Melbourne, Australia. All services were rendered in accordance with the Medical Board of Australia standards and the Mental Health Act 2014 (Victoria).
Please note that the Medicare Benefits Schedule (MBS) rebates listed are estimates based on current government rates. The actual rebate amount may vary slightly depending on the specific Medicare processing at the time of claim. Patients are responsible for the gap fee (the difference between the provider's fee and the Medicare rebate).
If you hold a valid Mental Health Treatment Plan from your General Practitioner, you are eligible for up to 10 subsidized sessions per calendar year. Please ensure your GP has updated your plan if you require further sessions.
For WorkCover or TAC (Transport Accident Commission) claims, please provide the relevant claim number and insurer details to ensure direct billing where applicable.
Level 4, 120 Collins Street
Melbourne, VIC 3000
Australia
Phone: +61 3 9000 1234
Email: [email protected]
ABN: 12 345 678 901
Medicare Provider Number: 987654321
INVOICE
Bill To:
Mr. James Anderson45 Chapel Street
South Yarra, VIC 3141
Melbourne, Australia
Medicare Card Number: 1234 5678 9012
Private Health Fund: Bupa Private Health
Member ID: BUP-99887766
| Description of Services | Medicare Item No. | Date | Fee (AUD) | MBS Rebate |
|---|---|---|---|---|
|
Initial Psychiatric Assessment Comprehensive evaluation of mental health status, including history taking, risk assessment, and formulation of diagnosis. Conducted at the Melbourne clinic. |
27 | 10 Oct 2023 | $350.00 | $185.00 |
|
Psychiatric Consultation (Standard) Follow-up consultation regarding treatment plan adherence, medication management, and symptom monitoring. |
23 | 17 Oct 2023 | $220.00 | $110.00 |
|
Psychiatric Consultation (Extended) Extended session for complex case management and adjustment of pharmacological regimen. |
26 | 24 Oct 2023 | $280.00 | $140.00 |
|
Psychiatric Report for WorkCover Detailed clinical report prepared for Victorian WorkCover Insurance Authority regarding fitness for duty. |
N/A | 24 Oct 2023 | $450.00 | $0.00 |
| Subtotal (Total Fees): | $1,300.00 |
| Less: Medicare Rebates: | -$435.00 |
| Less: Private Health Rebate (Est.): | -$150.00 |
| Out-of-Pocket Amount Due: | $715.00 |
This invoice reflects the professional fees charged by Dr. Eleanor Vance, a registered Psychiatrist practicing in Melbourne, Australia. All services were rendered in accordance with the Medical Board of Australia standards and the Mental Health Act 2014 (Victoria).
Please note that the Medicare Benefits Schedule (MBS) rebates listed are estimates based on current government rates. The actual rebate amount may vary slightly depending on the specific Medicare processing at the time of claim. Patients are responsible for the gap fee (the difference between the provider's fee and the Medicare rebate).
If you hold a valid Mental Health Treatment Plan from your General Practitioner, you are eligible for up to 10 subsidized sessions per calendar year. Please ensure your GP has updated your plan if you require further sessions.
For WorkCover or TAC (Transport Accident Commission) claims, please provide the relevant claim number and insurer details to ensure direct billing where applicable.
Payment Instructions
Payment is due within 30 days of the invoice date. We accept the following payment methods:
- Bank Transfer (BSB/Account): BSB: 082-123 | Account: 45678901 | Name: Victoria Private Psychiatry Clinic
- Credit Card: Visa, Mastercard, and Amex accepted via our secure online portal.
- Cash/EFTPOS: Available at our Melbourne clinic reception during business hours.
Please quote your Invoice Number (INV-2023-10-045) when making payment.
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