TAX INVOICE - REMINDER

UNLESS PAID WITHIN 14 DAYS,

FURTHER ACTION MAY BE TAKEN
INVOICE NUMBER 101203086

INVOICE DATE 04/04/2023

000003-000064 000
EMILENE DINIZ AMOUNT DUE $147.20
20A RAYMOND AVE
BUNDALL QLD 4217 DUE DATE 04/05/2023

24-hour automated credit card payments

1800 350 046 (24 Hour)
Have a payment question?
Please call 1800 350 046
Monday to Friday: 9:00am – 5:00pm
PATHOLOGY PROVIDER: DR DEBRA NORRIS PROVIDER No.: 0119517T
.
SERVICE
REF NO. SCP DESCRIPTION OF SERVICE ITEM NO. AMOUNT
DATE

30/03/23 56714536 ACC-3220 CHLM,GON 69317 $30.50

30/03/23 56714536 ACC-3220 MWFM 69312 $116.70

Tests requested:
For EMILENE DINIZ
By DR BRIDGET GILSENAN, Provider No. 420572EA
Date 30/03/2023

1
CONTINUED OVERLEAF

PLEASE KEEP THE TOP OF THIS INVOICE FOR YOUR RECORDS. PLEASE SEND A COPY OF THIS INVOICE TO MEDICARE AND / OR YOUR HEALTH FUND WITH YOUR CLAIM

Have a payment question?

PAYMENT SLIP - 3 Easy ways to pay Please call 1800 350 046
Monday to Friday: 9:00am – 5:00pm
39439IE/## E-64 S-190 I-190 000000

PATIENT NAME: INVOICE DATE: INVOICE NUMBER: AMOUNT DUE: DUE DATE:
EMILENE DINIZ 04/04/2023 101203086 $147.20 04/05/2023

Biller Code: 1002138 Phone: 24-hour automated

Biller Code: 747022 Ref: 1012 0308 6 credit card payments
Ref: 1012 0308 6 3 www.qml.com.au/patients/billing/#paying-bill 1800 350 046
Telephone & Internet Banking – BPAY®
Contact your bank or financial institution to make this
payment from your cheque, savings, debit, credit card
or transaction account. More info: www.bpay.com.au
®
Registered to BPAY Pty Ltd ABN 69 079 137 518
Thank you for your prompt payment
PLEASE SEE REVERSE FOR MORE WAYS TO PAY
Healius Pathology Pty Ltd. ABN 84 007 190 043, APA 000042, trading as QML Pathology
 HOW TO PAY YOUR ACCOUNT AND CLAIM A REFUND
Step 1 Please pay your account in full by the due date using one of the available payment methods.
Step 2 QML Pathology will send you a receipt once payment is received.
Step 3 To claim a refund from Medicare and/or your Health Fund, send a copy of this invoice and your QML
Pathology receipt along with your claim.

OTHER PAYMENT METHODS

MAIL - Please detach and send the payment slip at the bottom of this invoice along with a cheque or
money order made payable to "QML Pathology" to:
Accounts Department
Locked Bag 2288
St Leonards NSW 1590
A receipt will be sent to you once payment is received. Please do not send cash through the mail.

POST OFFICE – For your convenience this account can be paid at any AusPost office.

Ð*Ì8I!!4>v4 .hÎ0CÓ
Billpay Code: 2437
Ref: 1012 0308 6 2
*2437 101203086 2

SPECIAL ACCOUNTS

1. REPATRIATION PATIENT
Repatriation Number: .................................................................................................. Date of Birth:.........................

2. WORKCOVER – WORKER’S COMPENSATION

Claim Number: .................................................................................................................................

Employer: .................................................................................................................................

Employer’s Address .................................................................................................................................

Insurance Company .................................................................................................................................

Insurance Company’s Address: .................................................................................................................................

3. TRANSPORT ACCIDENT COMMISSION – MOTOR ACCIDENT

Claim Number:....................................... Date of Accident: .........................................Date of Birth:..........................

If you are covered by any of the above categories, you do not need to pay this account. Instead, please fill in the details
requested above and mail to:
QML Pathology Accounts Department, Locked Bag 2288, St Leonards NSW 1590
39439IE/## E-64 S-191 I-191 000000
 SERVICE
REF NO. SCP DESCRIPTION OF SERVICE ITEM NO. AMOUNT
DATE

NOTES:
#Denotes GST Applies
* REMINDER *
UNLESS PAID WITHIN 14 DAYS, FURTHER ACTION MAY BE TAKEN INVOICE AMOUNT $147.20
AMOUNT DUE $147.20

2
39439IE/## E-64 S-192 I-192 000000

Healius Pathology Pty Ltd. ABN 84 007 190 043, APA 000042, trading as QML Pathology