Quotation Estimate Surgeon in Australia Brisbane –Free Word Template Download with AI
Professional Surgical Services — Surgeon Consultation & Procedure
Queensland Health Services Pty Ltd | ABN: 48 123 456 789
Level 12, 400 George Street, Brisbane, Queensland 4000, Australia
Phone: +61 7 3100 2000 | Email: [email protected]
Australia Brisbane — QueenslandThis Quotation Estimate has been prepared by Queensland Health Services Pty Ltd, a registered medical practice operating in Australia Brisbane, to provide Mr. James A. Whitfield with a comprehensive and transparent financial breakdown of the anticipated costs associated with surgical services to be performed by a qualified Surgeon. This document serves as a formal Quotation Estimate and does not constitute a binding contract until accepted in writing by the client. All pricing is quoted in Australian Dollars (AUD) and reflects the current fee schedule as of the date of issue in Brisbane, Queensland.
The Surgeon assigned to this case is Dr. Sarah M. Chen, who holds Fellowship of the Royal Australasian College of Surgeons (FRACS) and is registered with the Australian Health Practitioner Regulation Agency (AHPRA). Dr. Chen has over 18 years of experience in general and laparoscopic surgery, having performed more than 4,200 procedures at leading hospitals in Australia Brisbane, including the Royal Brisbane and Women's Hospital (RBWH) and the Princess Alexandra Hospital. The Surgeon maintains full professional indemnity insurance through the Medical Defence Australia (MDA) and is accredited by the Australian Commission on Safety and Quality in Health Care (ACSQHC).
| Ref | Description of Service | Quantity | Unit Price (AUD) | Total (AUD) |
|---|---|---|---|---|
| 01 | Initial Surgeon Consultation & Pre-operative Assessment (Brisbane, QLD) | 1 session | $385.00 | $385.00 |
| 02 | Pre-operative Diagnostic Imaging (CT Scan & Blood Panel) — Brisbane Private Hospital | 1 package | $1,240.00 | $1,240.00 |
| 03 | Surgeon Fee — Primary Surgical Procedure (Laparoscopic Cholecystectomy) | 1 procedure | $4,850.00 | $4,850.00 |
| 04 | Anaesthetist Fee (General Anaesthesia, Australia Brisbane standards) | 1 session | $1,620.00 | $1,620.00 |
| 05 | Operating Theatre & Surgical Equipment Hire (Brisbane Private Hospital) | 1 session | $2,340.00 | $2,340.00 |
| 06 | Inpatient Hospital Accommodation & Nursing Care (1 night, Brisbane) | 1 night | $1,150.00 | $1,150.00 |
| 07 | Post-operative Surgeon Follow-up Consultations (2 visits within 6 weeks) | 2 visits | $220.00 | $440.00 |
| 08 | Pathology & Histology Analysis (Tissue Sample, Brisbane Lab) | 1 sample | $380.00 | $380.00 |
| 09 | Prescribed Medication & Post-operative Supplies (Brisbane Pharmacy) | 1 package | $195.00 | $195.00 |
| 10 | Emergency Contingency Allowance (Surgeon on-call, Australia Brisbane) | 1 provision | $450.00 | $450.00 |
| Subtotal (AUD) | $13,050.00 | |||
| GST (10%) — Australia Brisbane Tax | $1,305.00 | |||
| TOTAL QUOTATION ESTIMATE (AUD) | $14,355.00 | |||
The Surgeon, Dr. Chen, will perform a laparoscopic cholecystectomy as indicated by the pre-operative diagnostic findings. The procedure will be conducted at a private hospital facility in Australia Brisbane, specifically at the Brisbane Private Hospital located in the New Farm precinct. The Quotation Estimate encompasses all standard components of the surgical episode, including the Surgeon's professional fee, anaesthetic services, theatre time, inpatient care, and post-operative follow-up. Should the Surgeon identify the need for additional or alternative procedures intra-operatively, a supplementary Quotation Estimate will be provided to the patient or their nominated representative prior to any additional intervention, in accordance with the Australian Medical Association (AMA) guidelines on informed consent.
Terms Governing This Quotation Estimate
- Validity: This Quotation Estimate is valid for 30 calendar days from the date of issue. After this period, a revised Quotation Estimate may be required to reflect any changes in hospital fees, Surgeon availability, or Australian government health policy updates applicable in Brisbane, Queensland.
- Payment Schedule: A deposit of 20% (AUD $2,871.00) is due upon acceptance of this Quotation Estimate. The remaining 80% balance (AUD $11,484.00) is payable within 14 business days following the completion of the surgical procedure and discharge from the Brisbane hospital facility.
- Medicare & Private Health Insurance: The patient is advised to confirm their Medicare eligibility and private health insurance coverage prior to the procedure. The Surgeon's fee may attract a Medicare Benefits Schedule (MBS) rebate. Any gap between the Quotation Estimate total and the insurance rebate is the patient's responsibility. Queensland Health Services will provide a detailed itemised invoice for insurance claims.
- Cancellation Policy: Cancellation by the patient within 48 hours of the scheduled surgery date will incur a fee of 50% of the total Quotation Estimate. Cancellation by the Surgeon due to medical unfitness will result in a full refund of all deposits paid.
- Compliance: All services are delivered in compliance with the Australian Privacy Act 1988, the Health Records Act 2001 (Qld), and the National Safety and Quality Health Service (NSQHS) Standards. The Surgeon and all associated staff are bound by the Medical Board of Australia's Code of Ethics.
- Dispute Resolution: Any disputes arising from this Quotation Estimate shall be resolved in accordance with the Queensland Civil and Administrative Tribunal (QCAT) procedures, with jurisdiction in Brisbane, Queensland, Australia.
Based on the pre-operative assessment conducted in Brisbane, Queensland, the Surgeon recommends proceeding with the laparoscopic cholecystectomy as outlined in this Quotation Estimate. The patient's general health status, as confirmed by the pre-operative blood panel and cardiac clearance, is suitable for general anaesthesia. The Surgeon will personally perform the procedure and will be available for all post-operative follow-up consultations. The estimated operative time is 90 to 120 minutes, with an expected hospital stay of one night in Australia Brisbane. The patient will be provided with a detailed post-operative care plan, including dietary guidance, activity restrictions, and wound care instructions specific to the Brisbane climate conditions.
Prepared and Authorised By:
Dr. Sarah M. Chen, FRACS
Consultant Surgeon
Queensland Health Services Pty Ltd
Brisbane, Queensland, Australia
Signature & Date
Accepted By (Patient / Authorised Representative):
Mr. James A. Whitfield
New Farm, Brisbane, QLD 4005
Australia
Signature & Date
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