Invoice Surgeon in Australia Brisbane –Free Word Template Download with AI
Consultant General & Laparoscopic Surgeon
MBBS, FRACS (General Surgery)
Member: Royal Australasian College of Surgeons
Level 12, Medical Centre Tower
123 Queen Street
Brisbane, QLD 4000
Australia
Phone: +61 7 3000 1234 | Email: [email protected]
Invoice Number: INV-2023-8942
Date Issued: 24 October 2023
Due Date: 24 November 2023
Reference: Patient Account #99281
BILL TO:
Mr. Robert Henderson
45 River Terrace
New Farm, QLD 4005
Australia
Phone: 0412 345 678
Medicare Number: 1234 567890
Private Health Fund: Bupa Gold Hospital
Policy Number: BUP-882910
PROCEDURE DETAILS:
Date of Service: 15 October 2023
Facility: Brisbane Private Hospital
Procedure: Laparoscopic Cholecystectomy
Surgeon: Dr. James Sterling
Anesthetist: Dr. Sarah Chen
Diagnosis: Symptomatic Cholelithiasis
| Item | Description of Service | MBS Item No. | Fee (AUD) | Notes |
|---|---|---|---|---|
| 1 |
Surgeon's Fee - Laparoscopic Cholecystectomy Includes pre-operative assessment, surgical procedure, and immediate post-operative care. Performed at Brisbane Private Hospital. |
30251 | $2,450.00 | MBS Schedule |
| 2 |
Pre-Operative Consultation Comprehensive surgical assessment, review of imaging (ultrasound), discussion of risks/benefits, and consent process. |
23 | $185.00 | Bulk Billed |
| 3 |
Post-Operative Follow-Up Consultation Wound check, review of pathology results, and discharge planning. Conducted at Queen Street Clinic, Brisbane. |
23 | $185.00 | Gap Fee |
| 4 |
Pathology Fees (Surgeon's Referral) Histological examination of gallbladder tissue. |
N/A | $120.00 | Third Party |
| 5 |
After-Hours Call-Out Fee Emergency consultation regarding post-operative complications on 17 October 2023. |
N/A | $350.00 | Out of Hours |
| Subtotal (GST Exclusive) | $3,290.00 |
| GST (10%) | $329.00 |
| Medicare Rebate (Estimated) | -$1,150.00 |
| Private Health Fund Contribution (Estimated) | -$1,500.00 |
| PAYABLE BY PATIENT (OUT-OF-POCKET) | $969.00 |
Payment Instructions & Important Information
This Invoice represents the professional fees charged by the Surgeon, Dr. James Sterling, for services rendered in Australia Brisbane. Please note that the Medicare rebate and Private Health Fund contributions are estimates based on current schedules and your specific policy level. Actual rebates may vary.
Payment Methods:
Payments can be made via direct bank transfer, credit card (Visa/Mastercard), or EFTPOS in person at our Brisbane clinic.
Bank Transfer Details:
Bank: Commonwealth Bank of Australia
Account Name: Sterling Surgical Practice Pty Ltd
BSB: 062-000
Account Number: 12345678
Reference: INV-2023-8942
Terms & Conditions:
1. Payment is due within 30 days of the invoice date.
2. Late payments may incur interest charges at the rate of 1.5% per month.
3. This invoice is compliant with the Australian Taxation Office (ATO) requirements for GST registration.
4. Please retain this document for your personal records and for submission to your health fund if required.
5. For any queries regarding this invoice or your surgical care, please contact our Brisbane office during business hours (Monday-Friday, 8:30 AM - 5:00 PM AEST).
Thank you for trusting our Surgeon and our team with your healthcare needs in Australia Brisbane. We are committed to providing you with the highest standard of surgical care and administrative support.
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