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Pacific Clinic Medical

This document is a tax invoice from Pacific Private Clinic detailing a psychiatric consultation. It shows that Mr. Anderson Ordonez Diaz had a consultation with Dr. John Gavilan, a consultant psychiatrist, on February 22, 2021 for more than 45 minutes. The fee for the consultation was $470 which Mr. Diaz paid in full via EFTPOS credit on the same day, leaving a balance of $0.

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416 views1 page

Pacific Clinic Medical

This document is a tax invoice from Pacific Private Clinic detailing a psychiatric consultation. It shows that Mr. Anderson Ordonez Diaz had a consultation with Dr. John Gavilan, a consultant psychiatrist, on February 22, 2021 for more than 45 minutes. The fee for the consultation was $470 which Mr. Diaz paid in full via EFTPOS credit on the same day, leaving a balance of $0.

Uploaded by

Anderson
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Pacific Private Clinic

Dr Lee Williams – MBBS | FRACS ABN: 71 629 442 730


Pacific Private Clinic ___________EFT PAYMENT DETAILS
Dr John Gavilan – MBBS | FRACS
Dr Sandra Fang – BappSc | MBBS | Suite 3A/ Level 4 Pacific Private Clinic (Gold Coast) P/L
FRACS 119-123 Nerang Street Southport Qld 4215 Printed: 22/02/2021BSB Np: 064 244
Dr Sam Mikhaiel - MBBS | FRACS
Site: Pacific PrivateNo:
ACCOUNT 1077–4088
Clinic
P. 0408506775 F. 075561633 Please use Invoice # below &
E. reception@drjg.com.au GC
Patient Surname as EFT Reference
Page: 1
Mr Anderson Ordonez Diaz
9 Glen Eagles Drive
ROBINA QLD 4226

Tax Invoice / Receipt

Date Ite Description Fee GAP GST Paid Closing


m
Invoice #: 656403 Opening balance this invoice
$470.00
Receipt #: 657003 Date of receipt:
22/02/2021

Mr ANDERSON ORDONEZ DIAZ


File ID (0020097549)
Health Fund: BUPA #42914119
22/02/2021 291 470.00 0.00 0.00 470.00 0.00
Serviced provider: Dr John Gavilan (504668NT)
Refered by: Dr Sebastian Moss (5008516J)

Consultant psychiatrist, prepare a management plan,


more than 45 minutes

Closing balance this invoice


$0.00

Payment Allocation for this Receipt


EFTPOS Credit Account (1773) Payment in the amount of
$470.00
470.00 0.00 0.00 470.00 0.00

Unallocated Credit ________________0.00 This invoice


________470.00
This receipt
________470.00
Balance now due
__________0.00

PAYMENY ON THE DAY IS REQUESTED – PHONE, POSTAL & EFT PAYMENY DETAILS ARE ABOVE

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