Practice Name
The Doctor's registered practice name.
Practice Number
The Doctor's registered practice number.
Medical Aid
This should state "BP Medical Society"
Membership Number
Required to be the same number as on your medical aid card
Patient's Name
Full name of the patient
Patient's Birthdate
Birthdate of the patient, year month and day
Patients Dependant Code
This is a 2 digit code, eg. "01"
Date of service
Date of visit
ICD Code
This is a diagnosis code, eg."J11.1"
Tariff Code
Particular code for the service you received, often a 3 to 4 digit number.
Treatment cost
Amount billed for the goods or service.
Referring Doctor - Name and Practice Number
In the case of a referral, the doctors registered practice name and number is required.
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