MEDICARE CLAIMS HISTORY FOR KEVIN J ROBSON BETWEEN 15/05/2021 AND 15/08/2021

GPO Box 9822

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

PATIENT'S NAME KEVIN J ROBSON

MEDICARE CARD NUMBER 2270075301
INDIVIDUAL REFERENCE NUMBER 2
Date of Birth 06/07/1963

MEDICAL SERVICES

Services provided by: DR CHRISTOPHER HORNSBY

Date of Item Brief Item Description Total Cost Benefit Paid by Cost to Payment Method Reason
Service Number of Services Government Claimant Codes
06/08/2021 00104 Initial Specialist Attendance $184.00 $76.80 $107.20 EFT to Claimant
06/08/2021 11221 Full Quantitative Computerised Perimetry $270.00 $60.00 $210.00 EFT to Claimant

Total: $454.00 $136.80 $317.20

Services provided by: MISS ASHLEIGH CASEY
Date of Item Brief Item Description Total Cost Benefit Paid by Cost to Payment Method Reason
Service Number of Services Government Claimant Codes
13/07/2021 10910 COMPREHENSIVE INITIAL CONSULTATION - $59.05 $59.05 $0.00 Bulk Bill
PATIENT IS LESS THAN 65 YEARS OF AGE

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Services provided by: MISS ASHLEIGH CASEY
Date of Item Brief Item Description Total Cost Benefit Paid by Cost to Payment Method Reason
Service Number of Services Government Claimant Codes
13/07/2021 10940 Full Quantitive Computerised Perimetry $56.40 $56.40 $0.00 Bulk Bill

Total: $115.45 $115.45 $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 KEVIN J ROBSON at 9:57 AM on 15 Aug 2021.

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