National Private Patient Hospital Claim Form
The National Private Patient Hospital Claim form was designed to ensure all key stakeholders, including Commonwealth and State/Territory Departments of Health, and all Australian private hospitals, day facilities and public hospitals, and key associations and agencies, that this form is the standard national form to be completed for the payment of benefits for all admitted patient claims for all privately insured patients in private and public hospitals in Australia.
The PDF version of this form can be found here.
To order printed supplies of the form please contact:
| Supplier: | SDS Publications Locked Bag 500 Coorparoo DC Qld 4151 |
| Phone: | 1800 679 778 |
| Cat No. HH0050A: | National Private Patient Hospital Claim Forms |
| Price: | Cartons of 2000 (loose leaf) will be sold at a cost of: $90.91 ex GST ($100 inc GST). |
Postage & Handling:
POSTAGE & HANDLING - NATIONAL PRIVATE PATIENTS CLAIM FORM | ||||||
NO. OF CARTONS | 5 | $50.00 | $57.50 | $70.00 | $115.00 | $140.00 |
4 | $40.00 | $46.00 | $56.00 | $92.00 | $112.00 | |
3 | $30.00 | $34.50 | $42.00 | $69.00 | $84.00 | |
2 | $20.00 | $23.00 | $28.00 | $46.00 | $56.00 | |
1 | $10.00 | $11.50 | $14.00 | $23.00 | $28.00 | |
NSW | VIC | SA | WA | NT | ||
1000-2599 2620-2899 | 3000-3999 8000-8999 | 5000-5999 | 6000-6999 | 0800-0999 | ||
DESTINATION (POST CODE) | ||||||
POSTAGE & HANDLING - NATIONAL PRIVATE PATIENTS CLAIM FORM | |||||
NO. OF CARTONS | 5 | $30.00 | $51.00 | $65.00 | $81.00 |
4 | $24.00 | $40.80 | $52.00 | $64.80 | |
3 | $18.00 | $30.60 | $39.00 | $48.60 | |
2 | $12.00 | $20.40 | $26.00 | $32.40 | |
1 | $6.00 | $10.20 | $13.00 | $16.20 | |
QLD | |||||
4000-4209 | 4210-4449 4500-4699 | 4450-4499 4700-4805 | 4806-4899 | ||
DESTINATION (POST CODE) | |||||
SDS Publications requires prepayment and accepts credit cards/ money order/ cheques made payable to SDS Publications.
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14 March 2012
Hi Jill
Our undersatnding is that the hospital representatives are unable to sign. They either take it as a Medicare case, or ask the next of kin to sign.
Regards
Mia