MEDICARE CLAIMS HISTORY FOR FIZZA ALI BETWEEN 30/04/2021 AND 30/07/2021

GPO Box 9822

In your capital city
Enquires
132 011
www.servicesaustralia.gov.au

PATIENT'S NAME FIZZA ALI

MEDICARE CARD NUMBER 3564196241
INDIVIDUAL REFERENCE NUMBER 1
Date of Birth 01/01/1980

MEDICAL SERVICES

Services provided by: DR SAJEEWANA RATHNAYAKE

Date of Item Brief Item Description Total Cost Benefit Paid by Cost to Payment Method Reason
Service Number of Services Government Claimant Codes
24/05/2021 00036 CONSULTATION AT CONSULTING ROOMS - $75.05 $75.05 $0.00 Bulk Bill
LEVEL 'C'.

Total: $75.05 $75.05 $0.00

Services provided by: MR TIONG SAW
Date of Item Brief Item Description Total Cost Benefit Paid by Cost to Payment Method Reason
Service Number of Services Government Claimant Codes
05/05/2021 10910 COMPREHENSIVE INITIAL CONSULTATION - $58.55 $58.55 $0.00 Bulk Bill
PATIENT IS LESS THAN 65 YEARS OF AGE

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Services provided by: MR TIONG SAW
Date of Item Brief Item Description Total Cost Benefit Paid by Cost to Payment Method Reason
Service Number of Services Government Claimant Codes

Total: $58.55 $58.55 $0.00

Services provided by: DR KHALILULLAH AREFI
Date of Item Brief Item Description Total Cost Benefit Paid by Cost to Payment Method Reason
Service Number of Services Government Claimant Codes
29/07/2021 73806 Pregnancy test $8.65 $8.65 $0.00 Bulk Bill
29/07/2021 00054 LONG CONSULTATION of more than 25 $38.00 $38.00 $0.00 Bulk Bill
minutes duration but not more than 45
minutes duration.

Total: $46.65 $46.65 $0.00

End Of Report

Important information for you to know

Claiming information may not appear on your Medicare Claims History Statement for up to 48 hours.
This Medicare Claims History Statement cannot be used for the purpose of the Compensation Recovery Program or for claiming from Private Health Funds.
Services Australia does not hold information about services that may have been provided to public patients at public hospitals.
The accuracy of Medicare records depends on public patients being identified to Services Australia by their correct Medicare number and practitioners being
identified by their correct Medicare provider number, on claims for payment.
This Medicare Claims History Statement was printed by FIZZA ALI at 11:30 PM on 30 Jul 2021.

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