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  • Detailed Account Statement

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    This document is an account statement for Mr. Peter D Dembskey showing amounts owed for medical services. It details two visits in December 2020 and November 2022 for which amounts of R403.20 and R436.50 are due, as well as payments received. The total outstanding amount is R633.70. It provides bank details for electronic funds transfer and contact information for the medical practice.

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    This document is an account statement for Mr. Peter D Dembskey showing amounts owed for medical services. It details two visits in December 2020 and November 2022 for which amounts of R403.20 and R436.50 are due, as well as payments received. The total outstanding amount is R633.70. It provides bank details for electronic funds transfer and contact information for the medical practice.

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    © All Rights Reserved
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    16 views3 pages

    Detailed Account Statement

    Uploaded by

    denisdembskey
    This document is an account statement for Mr. Peter D Dembskey showing amounts owed for medical services. It details two visits in December 2020 and November 2022 for which amounts of R403.20 and R436.50 are due, as well as payments received. The total outstanding amount is R633.70. It provides bank details for electronic funds transfer and contact information for the medical practice.

    Copyright:

    © All Rights Reserved
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    of 3

    Account Statement 10 November 2022

    DR J. L. NEL INC
    Pr No: 1495682
    Account No. 5568
    38 MERCURY STREET
    FARRARMERE Tel: (011) 4251740 File Ref: Tel: (011) 9906600
    BENONI Admin: (011) 4251740 Cell: 0740800957
    5568
    1501 Fax: (011) 8499370
    Fax:
    VAT Reg No: 4870299734
    VAT No:
    Email: drjohannel@worldonline.co.za
    Website: Email: dembskeyd@gmail.com

    DEMBSKEY, PD MR
    9 STIRLING STREET

    BENONI
    1500

    Current 30 Days 60 Days 90 Days + Unallocated Total Med Aid Patient Due
    436.50 0.00 0.00 197.20 -0.00 633.70 0.00 633.70

    Fold

    Scheme Amount O/S MA Pat


    OTHER 0.00 0.00 0.00
    COMPCARE MEDICAL SCHEME - 1616850 633.70 0.00 633.70

    PAYMENTS RECEIVED * O/S MA Pat


    0.00 Pat 0.00 M/AID 633.70 0.00 633.70
    * Payments received in the last 30 days

    Funds exhausted - member liable THANK YOU FOR THE PAYMENTS

    For Electronic Funds Transfer, please use the following Bank Details:

    Account No: 4067090868 Account Name: DR JL NEL INC Our Ref: 5568
    Bank Name: ABSA Branch Code: 632005 Branch Name: EASTGATE

    DEMBSKEY, PD MR Acc No. 5568 Due. R 633.70 Amt Remit. R

    Page 1 of 3 Printed by MedEDI.


    Account Statement 10 November 2022

    DR J. L. NEL INC
    Pr No: 1495682
    Account No. 5568
    38 MERCURY STREET
    FARRARMERE Tel: (011) 4251740 File Ref: Tel: (011) 9906600
    BENONI Admin: (011) 4251740 Cell: 0740800957
    5568
    1501 Fax: (011) 8499370
    Fax:
    VAT Reg No: 4870299734
    VAT No:
    Email: drjohannel@worldonline.co.za
    Website: Email: dembskeyd@gmail.com

    DEMBSKEY, PD MR
    9 STIRLING STREET

    Scheme: COMPCARE MEDICAL SCHEME MUMED


    BENONI
    Main Member : MR PETER D DEMBSKEY
    1500
    Member No : 1616850

    Date Code Desc Ref Qty Amount MA Pat O/S MA Pat


    15/12/20 MR PETER D DEMBSKEY 8902205052086 403.20
    DOB: 20/02/1989 Dep No: 00 Mem No: 1616850
    Fold
    Trt Doc. NEL, JL Diag. F32.2
    0190 NEW AND ESTABLISHED PATIENT: 166832 1.0 403.20 403.20 197.20 197.20
    F32.2
    Payment Via Bank Transfer (26/03/2020) 20669 -6.00 0.00 -6.00
    Payment Via Bank Transfer (25/02/2021) 20877 -100.00 0.00 -100.00
    Payment Via Bank Transfer (25/02/2021) DEMBSKEY -100.00 0.00 -100.00
    01/11/22 MR PETER D DEMBSKEY 8902205052086 436.50
    DOB: 20/02/1989 Dep No: 00 Mem No: 1616850
    Trt Doc. NEL, JL Diag. R10.3
    0190 NEW AND ESTABLISHED PATIENT: 187669 1.0 436.50 436.50 436.50 436.50
    R10.3

    633.70 0.00 633.70

    Page 2 of 3 Printed by MedEDI.


    Account Statement 10 November 2022

    DR J. L. NEL INC
    Pr No: 1495682
    Account No. 5568
    38 MERCURY STREET
    FARRARMERE Tel: (011) 4251740 File Ref: Tel: (011) 9906600
    BENONI Admin: (011) 4251740 Cell: 0740800957
    5568
    1501 Fax: (011) 8499370
    Fax:
    VAT Reg No: 4870299734
    VAT No:
    Email: drjohannel@worldonline.co.za
    Website: Email: dembskeyd@gmail.com

    DEMBSKEY, PD MR
    9 STIRLING STREET

    Scheme: PRIVATE PATIENT SEP


    BENONI
    Main Member : MR PETER D DEMBSKEY
    1500
    Member No : Billed as Private

    Date Code Desc Ref Qty Amount MA Pat O/S MA Pat


    03/11/22 MR PETER D DEMBSKEY 8902205052086 0.00
    DOB: 20/02/1989 Dep No: 00 Mem No: Billed as Private
    Fold
    Trt Doc. NEL, JL Diag. N20.0
    0190 NEW AND ESTABLISHED PATIENT: 187733 1.0 0.00 0.00
    N20.0

    0.00 0.00 0.00

    Page 3 of 3 Printed by MedEDI.

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