Dr Anthony Hess

Billing practice no.: 0741930

Dr Anthony Hess Office no: 0218597515

1 Villiersdorp Road Email: anthess02@gmail.com
Grabouw
7160

Statement of Account Statement date: 03/04/2024

Mr GHALID ABADER Account no.: ABA1

Medical aid: DISCOVERY KEYCARE KEYCARE CORE OUT OF NETWORK

Member no.: 24003764680

Patient: Miss YASMEEN ABADER D.o.b: 29/10/2021 Dep. code: 03

Date of service: 02/04/2024 Treating provider: Dr Anthony Hess HPCSA: mp0618578 Treating prac. no.: 0741930
Invoice date: 02/04/2024 Invoice no.: 2404-00002
Referral no.: 1111 Lab ref. no.: 1111
Referring provider: Alphie Shikwambana (null) Assisting provider: Dr Anthony Hess (null)

ICD-10 diagnosis: N30.0 Status: Awaiting Response

Tariff Description Amount Med. aid liable Patient liable Balance

code

0190 New and established patient: Consultation/visit of new R 483.20 R 483.20 R 0.00 R 483.20
or established patient of an average duration and/or
complexity. Includes counselling with the patient and/
or ...
ICD-10: N30.0
PPE01 Personal Protective Equipment (PPE) R 0.00 R 0.00 R 0.00 R 0.00
ICD-10: N30.0

VAT on invoice: R 63.03 R 483.20 R 0.00 R 483.20

SUMMARY Due by patient R 0.00

Due by med. aid R 483.20

Balance R 483.20

120+ days 90 - 120 days 60 - 90 days 30 - 60 days 0 - 30 days

R 0.00 R 0.00 R 0.00 R 0.00 R 483.20

Bank details Dr AJ Hess, Standard Bank, Branch: 33012, Account no.: 072367105, Account type: Cheque

EFT info Payment ref.: ABA1, Send proof of payment to: anthess02@gmail.com

Company info VAT no: 4231231231

Page 1 of 1 Please note that you are personally liable for any difference between the
claimed amount and the amount paid by your medical aid.