Jane Citizen 29 Sample Street Sampletown NSW 2000
ABN
000
Brookhollow Avenue Baulkham Hills NSW 2153 Phone
Address
5999
Customer Id : AC001111111
Id : 0444444444
From : 01/07/2022 Statement To : 31/07/2022
HomeCare Package Level : Level 3 Care facilitator : John Smith
Opening Balance $1,723.04
Your Home Care Package Subsidy (Held by BaptistCare on your behalf)
Your Contribution (Held by BaptistCare on your behalf) Your Home Care Account balance (Held by the Government on your behalf)
Incoming Funds
$538.77 $143.93 $1,040.34
Total Government Contribution to Home Care package $2,501.70
Total Client Contribution $482.67
Total Income $2,984.37
Spent from your plan
Care and service charges $509.15
Premiums $737.00
Items $0.00
Total Spent $1,246.15
$351.56
Your Home Care Package Subsidy (Held by BaptistCare on your behalf) $270.78
Your Contribution (Held by BaptistCare on your behalf) $0.00
Your Home Care Account balance (Held by the Government on your behalf) $3,542.04
All clients are strongly encouraged
during services, particularly during transport services. Please let the office know if you or a household member have any COVID symptoms.
wear a
unique
period of
level of your Home Care Package.
Care Facilitator’s name.
The balance carried over from your last statement as well as the breakdown of those funds and where those funds are being held.
The funds that have been received during the statement period.
The funds that have been spent during the statement period.
The total of adjustments and refunds from the previous statement period.
The total amount of unspent Home Care Package funding available at the end of the statement period as well as the breakdown of those funds and where those funds are being held.
10 Contributions that you’ve made towards the cost of your care and services.
11
The care and service information is itemised to show when you received it, who delivered it, what service it was and how the cost was calculated.
These include specialised services and equipment, and BaptistCare charges.
13 If you have any questions about these adjustments, please speak with your Care Facilitator.
*The statement shown is an example only.
statement will have different content
each section that is relevant to you.
Incoming Funds - Client Contributions
Date Description
31/07/2022 Your Income Tested Fee
Incoming Funds - Government Contributions
Date Description
Quantity Rate Amount
31 days $15.57 $482.67
Total Client Contributions $482.67
Quantity Rate Amount
31/07/2022 Your Home Care Package Subsidy 31 days $79.09 $2,501.70
Total Government Contributions to Home Care Package $2,501.70
Care and Service
Date Time Service By Quantity Amount
02/07/2022 01:48PM - 03:18PM Housekeeping
Felisa 1.5 hours $89.85 04/07/2022 11:45AM - 12:45PM Housekeeping
Yelena 1 hour $59.90 09/07/2022 09:45AM - 11:15AM Housekeeping
Luisa 1.5 hours $89.85 11/07/2022 12:32PM - 01:32PM Housekeeping
Felisa 1 hour $59.90 18/07/2022 12:32PM - 01:32PM Housekeeping
Yelena 1 hour $59.90 23/07/2022 10:22AM - 11:52AM Housekeeping
Felisa 1.5 hours $89.85 25/07/2022 01:55PM - 02:55PM Housekeeping
Premiums
Statement Date
Description
Felisa 1 hour $59.90
Total Care and Service $509.15
Quantity Rate Amount
01/07/2022 Care Management Level 3 350.00 $350.00 14/07/2022 Physiotherapy GST Free: Super
SRS22080602 7/2/22 visit 100.00 $100.00
01/07/2022 Package Management Level 3 287.00 $287.00
Total Premiums $737.00
Adjustments
Date Name
22/07/2022 HCP
Amount
(To You) $226.00 22/07/2022
(To You) $133.00 25/07/2022
-$7.44
Total Adjustments $351.56
Q: I have a question about my statement. Who should I contact?
Please contact your Care Facilitator
Q: Who else can can I contact?
If you would prefer to discuss your fees and services with an independent third party, you can contact the Older Persons Advocacy Network (OPAN). OPAN can connect you to a representative to discuss your needs on a confidential basis. Please refer to their website www.opan.org.au or call them on 1800 700 600 for more information.
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