Private Imaging

The Royal Melbourne Hospital

The Royal Melbourne Hospital, Parkville, 3050
Tel: 9342 4491 or 9342 7051 Fax: 9342 7862
ABN: 73802706972

LSPN: 002415 ACCOUNT PAYABLE

Payment Terms 7 Days
RMH Provider Number: 0031030B
Account to: MISS YU, Jennilyn Invoice Date: 27/01/2022
599 SWANSTON ST Invoice No: 1382210 /
CARLTON 3053 Page No: OS_PayUp_FRO
NT
1 of 1
Patient: MISS Jennilyn YU PCR No: 88110584
599 SWANSTON ST URNO: 9344825
CARLTON 3053 Medicare No:
HFund No: /
Servicing Provider: DR STEFAN HEINZE (240914EB) DOB: 19/09/1994

Date Time Service Item Referred Claim No. Amount

No. Date
Services for: MISS YU, Jennilyn 19/09/1994; Request: 2022R0001764 (Outpatient, Dr
CHATFIELD, Simon [2430092K])
05/01/2022 11:20 Chest Plain (not Mobile) 58503 05/01/2022 $72.45
Notes: Excl. Tax $72.45
Tax $0.00
TOTAL $72.45

PAYMENT TERMS 7 DAYS

PAYMENT OPTIONS - Return this section with your payment
1. BPAY® TELEPHONE AND INTERNET BANKING
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

2. CREDIT CARD Complete below and post to: Private Imaging, The Royal Melbourne
Hospital, Locked Bag 860, Carlton South, 3053 Surname: YU
OR telephone 1300 133 096 24hrs a day with credit card details
Given Name: Jennilyn
Post this portion with cheque/money order to:
3. BY MAIL Invoice Date: 27/01/2022
Private Imaging, The Royal Melbourne Hospital, Locked Bag 860,
Carlton South, 3053 Invoice No: 1382210
Please make cheque payable to: Private Imaging

Present this account at Private Imaging, The Royal Melbourne Hospital, AMOUNT DUE: $0.00
4. IN PERSON
Parkville, 3050
Master Card Bank Card VISA Credit Card No:

Card Holders Name: ________________________________________

Expiry Date: _________________ Amount Paying: _________________ Credit Card Verification Number: