Invoice Surgeon in Australia Sydney –Free Word Template Download with AI
Consultant General & Laparoscopic Surgeon
Level 12, Medical Centre Tower
100 George Street, Sydney NSW 2000
Australia
Phone: +61 2 9555 0123
Email: [email protected]
ABN: 12 345 678 901
Medical Board Registration: 1234567890
Billed To (Patient)
Mr. James Robert Wilson
42 Harbour View Drive
Manly, NSW 2095
Sydney, Australia
Medicare Card No: 1234 5678 9012
Private Health Fund: Bupa Gold
Policy Number: BUP-99887766
Bill To (Private Health Fund)
Bupa Private Health Insurance
Claims Department
GPO Box 1000
Sydney NSW 2001
Australia
Note: Please remit payment directly to the Surgeon's bank account detailed below.
| Item | Description of Surgical Services | MBS Item No. | Fee (AUD) | GST |
|---|---|---|---|---|
| 1 |
Pre-operative Surgical Consultation Comprehensive assessment of patient history, physical examination, and surgical planning for elective procedure. Includes discussion of risks, benefits, and alternatives in accordance with Australian medical standards. |
23 | $350.00 | $0.00 |
| 2 |
Laparoscopic Cholecystectomy Surgical removal of the gallbladder via minimally invasive laparoscopic technique. Performed at Royal North Shore Hospital, Sydney. Includes surgical time, technical skill, and intra-operative decision making. |
30168 | $2,850.00 | $0.00 |
| 3 |
General Anaesthesia Supervision Coordination with anaesthetist for safe administration of anaesthesia during the surgical procedure. |
N/A | $450.00 | $0.00 |
| 4 |
Post-operative Ward Visit (Day 1) Clinical review of patient condition, wound inspection, and management of post-surgical pain and recovery protocols. |
23 | $220.00 | $0.00 |
| 5 |
Post-operative Follow-up Consultation Review of surgical outcome, suture removal (if applicable), and clearance for return to normal activities. Conducted at Sydney Private Clinic. |
23 | $280.00 | $0.00 |
| 6 |
Medical Report for Insurance Detailed clinical report outlining the necessity of the surgery and outcome for private health fund claims processing. |
N/A | $150.00 | $15.00 |
Payment Instructions
Please make all payments in Australian Dollars (AUD). Payments can be made via direct bank transfer or credit card.
Bank Transfer Details:
Bank: Commonwealth Bank of Australia
BSB: 062-000
Account Name: Dr. A. Thorne Surgical Trust Account
Account Number: 1234 5678
Please quote Invoice Number INV-2023-8942 in the payment reference.
Terms and Conditions
1. Medicare Benefits: This invoice reflects the surgeon's fee. Medicare rebates may apply to eligible services. Please present this invoice to Medicare or your private health fund for claim processing.
2. Out-of-Pocket Expenses: The patient is responsible for any gap fees between the surgeon's fee and the Medicare/private health fund rebate.
3. Due Date: Payment is due within 30 days of the invoice date. Late payments may incur interest charges in accordance with Australian consumer law.
4. Disputes: Any disputes regarding this invoice must be raised in writing within 14 days of receipt.
5. Privacy: Patient information is handled in strict accordance with the Privacy Act 1988 (Cth) and Australian Privacy Principles.
Authorized By:
Dr. Alexander Thorne
Consultant Surgeon
Patient Acknowledgement:
I acknowledge receipt of this invoice and understand my financial obligations.
Signature: __________________________
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