AROGYA FAMILY PRACTICE

TAX INVOICE/
STATEMENT

PO BOX 2057 Date: 16/10/2023

OTJIWARONGO Practice: 0140000556556
NAMIBIA Account: ROB0006
adm.arogya@gmail.com Page: 1 of 3
TEL: (067) 314900 FAX: (067) 314901

MR.J.F.ROBBERTSE Medical fund reference:

P.O BOX 18 RENAISSANCE ESTEEM CARE
KAMANJAB 510596
NAMIBIA Main member identity number:
7606191011800

E-Mail: vryheid@iway.na
Cellular: 264811290787
Home: 264812274380

Date: Dependent: Provider: BHF/Details: Amount: Medical: Self: Due:

ANTONETTA ROBBERTSE C: 264812274380

Dependent: ANTONETTA / Born: 01/10/1975 / Number: 01

DR L MIENIE - 0140001571095 [BHF: 0140001571095]

03/10/2023 ANTONETTA: 01/10/1975
DR L MIENIE - 01.. 0101 x1 At doctors rooms or home N$480.40 N$0.00 N$480.40 N$480.40

BENEFIT LIMIT EXCEEDED, MEMBER LIABLE FOR OUTSTANDING

ICD-10: Z01.4

EDI details: QEDI: Submitted: Batch: 650

03/10/2023 ANTONETTA: 01/10/1975
DR L MIENIE - 01.. 0210 x1 Collection of blood specimen(s) for pathology N$66.40 N$0.00 N$66.40 N$66.40

EDI details: QEDI: Submitted: Batch: 650

03/10/2023 ANTONETTA: 01/10/1975
DR L MIENIE - 01.. 0201 x1 NAPPI: 665258003 / Alcohol swab 175064 swb small N$0.40 N$0.00 N$0.40 N$0.40

EDI details: QEDI: Submitted: Batch: 650

JOHANNES ROBBERTSE C: 264811290787

Dependent: JOHANNES / Born: 01/01/2008 / Number: 03

03/10/2023 JOHANNES: 01/01/2008
DR L MIENIE - 01.. 0201 x1 NAPPI: 591580004 / Linen savers 200s 6ply csm 650x1 N$4.15 N$0.00 N$4.15 N$4.15

EDI details: QEDI: Submitted: Batch: 650

03/10/2023 JOHANNES: 01/01/2008
DR L MIENIE - 01.. 0201 x1 NAPPI: 410360001 / Dressing tray double forcep kit N$23.53 N$0.00 N$23.53 N$23.53

EDI details: QEDI: Submitted: Batch: 650

03/10/2023 JOHANNES: 01/01/2008
DR L MIENIE - 01.. 0201 x1 NAPPI: 652019001 / Needle 18g pink 20x38mm h/hease N$0.75 N$0.00 N$0.75 N$0.75

EDI details: QEDI: Submitted: Batch: 650

03/10/2023 JOHANNES: 01/01/2008
DR L MIENIE - 01.. 0201 x15 NAPPI: 715837001 / Supiroban oin 20mg/g 15g N$89.10 N$0.00 N$89.10 N$89.10

EDI details: QEDI: Submitted: Batch: 650

03/10/2023 JOHANNES: 01/01/2008
DR L MIENIE - 01.. 0101 x1 At doctors rooms or home N$480.40 N$0.00 N$480.40 N$480.40

BENEFIT LIMIT EXCEEDED, MEMBER LIABLE FOR OUTSTANDING

ICD-10: L03.9

EDI details: QEDI: Submitted: Batch: 650

ANTONETTA ROBBERTSE C: 264812274380

Dependent: ANTONETTA / Born: 01/10/1975 / Number: 01

CONTINUES ON NEXT PAGE....

PDF created with pdfFactory trial version www.pdffactory.com

 AROGYA FAMILY PRACTICE
TAX INVOICE/
STATEMENT

PO BOX 2057 Date: 16/10/2023

OTJIWARONGO Practice: 0140000556556
NAMIBIA Account: ROB0006
adm.arogya@gmail.com Page: 2 of 3
TEL: (067) 314900 FAX: (067) 314901

MR.J.F.ROBBERTSE Medical fund reference:

P.O BOX 18 RENAISSANCE ESTEEM CARE
KAMANJAB 510596
NAMIBIA Main member identity number:
7606191011800

E-Mail: vryheid@iway.na
Cellular: 264811290787
Home: 264812274380

Date: Dependent: Provider: BHF/Details: Amount: Medical: Self: Due:

09/10/2023 ANTONETTA: 01/10/1975

DR L MIENIE - 01.. 0130 x1 Telephone or e-mail consultation (all hours) N$326.50 N$0.00 N$326.50 N$326.50

BENEFIT LIMIT EXCEEDED, MEMBER LIABLE FOR OUTSTANDING

ICD-10: R94.7

EDI details: QEDI: Submitted: Batch: 651

ANTONETTA ROBBERTSE C: 264812274380 W: 264811290787

Dependent: ANTIONETTE / Born: 12/07/2006 / Number: 02

16/10/2023 ANTIONETTE: 12/07/2006
DR L MIENIE - 01.. 0101 x1 At doctors rooms or home N$480.40 N$0.00 N$480.40 N$480.40

ICD-10: K29.1

16/10/2023 ANTIONETTE: 12/07/2006

DR L MIENIE - 01.. 3618 x1 Pelvic organs ultrasound transabdominal probe N$500.00 N$0.00 N$500.00 N$500.00

ICD-10: K29.1

JOHANNES ROBBERTSE C: 264811290787

Dependent: JOHANNES / Born: 01/01/2008 / Number: 03

16/10/2023 JOHANNES: 01/01/2008
DR L MIENIE - 01.. 0202 x1 Setting of sterile tray: a fee of 10,00 clinica N$164.50 N$0.00 N$164.50 N$164.50

16/10/2023 JOHANNES: 01/01/2008

DR L MIENIE - 01.. 0201 x1 NAPPI: 591580004 / Linen savers 200s 6ply csm 650x1 N$5.98 N$0.00 N$5.98 N$5.98

16/10/2023 JOHANNES: 01/01/2008

DR L MIENIE - 01.. 0201 x2 NAPPI: 697176002 / Gauze swabs 100x100x8ply n/s swb N$2.72 N$0.00 N$2.72 N$2.72

16/10/2023 JOHANNES: 01/01/2008

DR L MIENIE - 01.. 0201 x1 NAPPI: 207637 / Gloves all sizes surgical p/f csm s N$32.40 N$0.00 N$32.40 N$32.40

16/10/2023 JOHANNES: 01/01/2008

DR L MIENIE - 01.. 0201 x2 NAPPI: 536342 / Gloves all sizes sterile pow csm sl N$4.32 N$0.00 N$4.32 N$4.32

16/10/2023 JOHANNES: 01/01/2008

DR L MIENIE - 01.. 0201 x1 NAPPI: 640906001 / Needle dental 27g kbm long ndl 2 N$1.99 N$0.00 N$1.99 N$1.99

16/10/2023 JOHANNES: 01/01/2008

DR L MIENIE - 01.. 0201 x4 NAPPI: 778826007 / Xylotox se inj 2% 1.8ml N$47.64 N$0.00 N$47.64 N$47.64

16/10/2023 JOHANNES: 01/01/2008

DR L MIENIE - 01.. 0201 x1 NAPPI: 605114001 / Blade scalpel csm size15scapel00 N$0.78 N$0.00 N$0.78 N$0.78

16/10/2023 JOHANNES: 01/01/2008

DR L MIENIE - 01.. 0201 x1 NAPPI: 469178002 / Crepe bandage 50mm ban040 ban 50 N$11.34 N$0.00 N$11.34 N$11.34

16/10/2023 JOHANNES: 01/01/2008

DR L MIENIE - 01.. 0201 x1 NAPPI: 836427009 / Jelonet peel pack tul 10x10cm663 N$11.66 N$0.00 N$11.66 N$11.66

16/10/2023 JOHANNES: 01/01/2008

DR L MIENIE - 01.. 0108 x1 Subsequent consultation/visit at rooms (once N$387.10 N$0.00 N$387.10 N$387.10

16/10/2023 JOHANNES: 01/01/2008

DR L MIENIE - 01.. 0310 x1 Radical excision of nailbed N$777.00 N$0.00 N$777.00 N$777.00

VAT of N$0.00 included

*** PRACTICE BANK DETAILS ***

CONTINUES ON NEXT PAGE....

PDF created with pdfFactory trial version www.pdffactory.com

 AROGYA FAMILY PRACTICE
TAX INVOICE/
STATEMENT

PO BOX 2057 Date: 16/10/2023

OTJIWARONGO Practice: 0140000556556
NAMIBIA Account: ROB0006
adm.arogya@gmail.com Page: 3 of 3
TEL: (067) 314900 FAX: (067) 314901

MR.J.F.ROBBERTSE Medical fund reference:

P.O BOX 18 RENAISSANCE ESTEEM CARE
KAMANJAB 510596
NAMIBIA Main member identity number:
7606191011800

E-Mail: vryheid@iway.na
Cellular: 264811290787
Home: 264812274380

Date: Dependent: Provider: BHF/Details: Amount: Medical: Self: Due:

BANK WINDHOEK - OTJIWARONGO - AROGYA FAMILY PRACTICE

BRANCH CODE: 481-573 ACCOUNT NR:8003904598 - USE YOUR ACCOUNT NR AS REF

Due patient: Due medical: Current: 30 days: 60 days: 90 days: 90 day+: Payable:
N$3899.46 N$0.00 N$3899.46 N$0.00 N$0.00 N$0.00 N$0.00 N$3899.46

STATEMENT IN ACCORDANCE WITH SCALE OF BENEFITS

FAX OR EMAIL PROOF OF PAYMENT PLEASE
TRANSACTIONS NOT PAID BY MEDICAL FUND WILL BE THE PATIENT RESPONSIBILITY

PDF created with pdfFactory trial version www.pdffactory.com