Quotation Estimate Doctor General Practitioner in Australia Brisbane –Free Word Template Download with AI
Professional Medical Services — Doctor General Practitioner
AUSTRALIA BRISBANE
Provider Details
Brisbane Riverside Medical Centre
Doctor General Practitioner Services
42 Flinders Street, South Brisbane, QLD 4101
Australia Brisbane, Queensland
Phone: +61 7 3855 4200
Email: [email protected]
ABN: 54 123 456 789
AHPRA Registration: 1234567
Client / Patient Details
Mr. James A. Whitfield
187 Anzac Parade, Hamilton
Brisbane, QLD 4007
Australia Brisbane, Queensland
Phone: +61 4 1234 5678
Medicare Card No: 1234 5678 9012
Date of Birth: 14/03/1975
This Quotation Estimate has been prepared by Brisbane Riverside Medical Centre to provide Mr. James A. Whitfield with a comprehensive and transparent breakdown of anticipated medical fees for a scheduled course of Doctor General Practitioner services. As a registered Doctor General Practitioner operating within Australia Brisbane, our practice is committed to ensuring that all patients receive clear, itemised cost information prior to the commencement of any treatment plan. This document serves as a formal Quotation Estimate and does not constitute a binding invoice until the services have been rendered and the patient has provided written acceptance.
| Ref | Description of Service | MBS Item No. | Qty | Unit Price (AUD) | Total (AUD) |
|---|---|---|---|---|---|
| 01 | Initial Doctor General Practitioner Consultation — Comprehensive health assessment, medical history review, and physical examination conducted in Australia Brisbane | 701 | 1 | $125.00 | $125.00 |
| 02 | Follow-up Doctor General Practitioner Consultation — Review of initial findings, discussion of treatment options, and referral coordination within the Australia Brisbane health network | 701 | 2 | $110.00 | $220.00 |
| 03 | Full Blood Panel & Biochemistry Screening — Ordered by the Doctor General Practitioner, processed at Brisbane Pathology, Australia Brisbane | 701 (ancillary) | 1 | $95.00 | $95.00 |
| 04 | Electrocardiogram (ECG) — 12-lead cardiac screening performed on-site at the Australia Brisbane clinic | 701 (ancillary) | 1 | $78.00 | $78.00 |
| 05 | Chronic Disease Management Plan (CDMP) — Development and documentation of a 12-month management plan by the Doctor General Practitioner in accordance with Australian health guidelines | 721 | 1 | $145.00 | $145.00 |
| 06 | Referral to Specialist (Cardiology) — Referral letter preparation and coordination by the Doctor General Practitioner, Australia Brisbane, to a specialist within the Brisbane metropolitan area | 721 (ancillary) | 1 | $65.00 | $65.00 |
| 07 | Medication Management & Prescription Renewal — Ongoing pharmaceutical oversight by the Doctor General Practitioner for a period of three months | 701 | 3 | $85.00 | $255.00 |
| 08 | Health Certificate & Work Fitness Assessment — Issued by the Doctor General Practitioner for employment purposes, compliant with Queensland and Australia Brisbane regulatory standards | 701 | 1 | $95.00 | $95.00 |
| SUBTOTAL (AUD) | $1,078.00 | ||||
| Medicare Rebate (estimated) | -$612.00 | ||||
| PATIENT OUT-OF-POCKET BALANCE (AUD) | $466.00 | ||||
- This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After this period, fees may be subject to revision in accordance with current Australian Medical Association (AMA) fee schedules applicable to Doctor General Practitioner services in Australia Brisbane.
- All prices are quoted in Australian Dollars (AUD) and are inclusive of Goods and Services Tax (GST) where applicable. Medicare rebate amounts are estimates based on current Australian Government Medicare Benefits Schedule (MBS) rates and are subject to change.
- The Doctor General Practitioner at Brisbane Riverside Medical Centre reserves the right to adjust the scope of services if clinical findings during the initial consultation warrant additional or alternative investigations. Any such adjustments will be communicated to the patient prior to additional charges being incurred.
- Payment of the patient out-of-pocket balance is due within fourteen (14) days of the final service date. Our practice in Australia Brisbane accepts EFTPOS, bank transfer, and major credit cards. HICAPS on-the-spot Medicare claiming is available for eligible services.
- This Quotation Estimate does not guarantee a specific medical outcome. The Doctor General Practitioner will exercise all reasonable clinical judgement in the delivery of services in accordance with the standards of care expected of a registered medical practitioner in Australia Brisbane.
- Should the patient wish to cancel or reschedule any appointment, a cancellation fee of $50.00 AUD may apply if notice is given less than twenty-four (24) hours prior to the scheduled time, in line with standard Doctor General Practitioner practice policies in Australia Brisbane.
- All patient records, clinical notes, and documentation generated as part of this course of treatment will be maintained in accordance with the Privacy Act 1988 (Cth) and the Australian Privacy Principles. Records are stored securely at our Australia Brisbane facility and are accessible to the patient upon written request.
- This Quotation Estimate is prepared in good faith by the Doctor General Practitioner and the administrative team at Brisbane Riverside Medical Centre. It is intended solely for the named patient and may not be transferred or assigned to a third party without prior written consent.
By signing below, the patient acknowledges that they have received and reviewed this Quotation Estimate for Doctor General Practitioner services at Brisbane Riverside Medical Centre, Australia Brisbane. The patient confirms their understanding of the estimated costs, the Medicare rebate provisions, and the terms and conditions outlined above. This signature constitutes acceptance of the Quotation Estimate and authorises the Doctor General Practitioner to proceed with the scheduled services.
Patient SignatureMr. James A. Whitfield
Date: _______________ Doctor General Practitioner
Dr. Sarah M. Chen, MBBS, FRACGP
Brisbane Riverside Medical Centre, Australia Brisbane
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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