Dr Jubal John

Your obstetrician has involved me in your care which must mean that either you are about to have a baby or have just had a new baby! I'm Dr. Jubal John, a specialist neonatologist (newborn ICU doctor) and general paediatrician. I'm glad to be of assistance at this exciting but potentially challenging time.

To enable me to provide better care for your baby please take a few minutes to complete this form. Information about billing is also detailed below to assist you with providing informed financial consent.

Baby's name

Leave blank if you haven't decided on one yet!

First Name

Last Name

Your baby's date of birth (or anticipated delivery date)

Date

Mother's name

First Name

Last Name

Mother's date of birth

Date

Email address

Please enter an address you will be regularly checking as we will use this as the primary means of communicating with you about your baby's paediatric care.

Your Address

Street

City

ZIP / Postal Code

State / Province

Country

Mobile

Partner's name

First Name

Last Name

GP Name

First Name

Last Name

Clinic Name

GP Address

Address

Suburb

Please enter your family Medicare number below

Were there any complications during this pregnancy?

Thyroid disease

Breech position (baby bottom first)

Other

No complications

Were you taking any medication during the pregnancy?

Vitamin D supplements

Other

No supplements other than pregnancy multivitamins

Were there any abnormalities on your ultrasound scans? If you selected 'other' above please provide any further details in this section

Anything else I should know?

An invoice for the paediatric care is emailed to you a few weeks after discharge. You can claim medicare benefits on my fees. The total cost varies as the billing is based on individual clinical needs. The minimum out of pocket 'gap' after the medicare rebate is $300 and the maximum 'gap' is $1800. Your out of pocket expense is substantially lower if you have reached the medicare safety net for the calender year, as medicare then covers 80% of your out of pocket expenses.

Initial attendance fees

	Billed amount	MBS item number	Gap after medicare	Gap with safety net
Elective review (in hours)	$500	110	$352	$100
Elective c-section (in hours) or Elective review on weekend	$600	110	$452	$120
Emergency c-section (in hours) or Weekend Elective c-section	$750	110	$602	$250
After hours/ Weekend attendance	$950	110	$802	$450
Overnight attendance (10pm to 8am)	$1300	110	$1152	$800

These fees are indicative only, and the final fees may differ. After-hours and emergency attendance incur higher fees, as I am specifically called to the hospital to attend. Your health fund will not routinely cover my fees if your baby remains on the postnatal ward as the baby is considered an outpatient of the hospital.

Hospital fees are more expensive that visits to a specialist in clinic for a number of reasons including the need to have 24/7 availability. Between my colleagues and I, a specialist paediatrician is available all the time for emergencies. There is no separate fee for the round the clock medical cover, however these costs are factored into the fees.

Procedures, follow-up reviews in hospital and in clinics are billed additionally (and have separate medicare item numbers and rebates).

Subsequent Attendance Fees

Following my initial attendance, I will come and check on your baby until you are discharged home (unless you and your baby are well enough to be transferred to the Hotel). This is to check for a number of common concerns that arise in the first few days after birth and to work with the midwifery staff on your baby's feeding plan. If I am away, or unavailable, one of the other paediatricians in our practice will cover for me and visit instead. If this is the case, you will also receive a bill from them.

I charge $250 for your baby's discharge check, and any other occasion when there is a full clinical review. The fee incorporates the cost of providing a 24-hour service. The Medicare rebate for these consultations is $74.25. Other subsequent attendances are charged at $87.30 or $49.75 depending on the level of complexity; the Medicare rebates for these consultations are $74.25 (Item 116) and $42.30 (Item 119) respectively.

Most babies won't need any further follow-up with me after discharge but all babies need a check at six weeks of age - this should be performed by your local GP. I will let you know if you need to bring your baby back to my consulting rooms to see me for a further review. If your baby does need to come back and see me again, this is associated with a separate fee (more information will be provided to you at the time of making the appointment).

Please confirm the following:

I understand and consent to the care being provided to my baby by my paediatrician at the request of my obstetrician

I consent to the collection and storage of personal medical information and the distribution of this information to relevant parties where necessary

I allow the clinical information collected to be used anonymously for clinical practice improvement, artificial intelligence and research

I understand that there are fees for this paediatric service and out of pocket costs as detailed above

I consent to electronic communication including medical results using my email address and SMS

I consent to medicare being billed on my behalf for eligible services.

Signature

Date signed

Date