Pnb Application Form for Clerk, 2009 by qxv49469

VIEWS: 0 PAGES: 35

Pnb Application Form for Clerk, 2009 document sample

More Info
									                      Invoicing and Debt Control
                          P rivate P atients Ch arges
R eference N u m ber:

N H S C T /0 9 /2 2 4

R es p ons ible Directorate:

F in a n c e

R ep laces (if a p p ro p ria te ):

In te rn a l P ro c e d u re s o n In v o ic in g a n d D e b t C o n tro l – P riv a te P a tie n ts C h a rg e s
u s e d b y fo rm e r le g a c y T ru s ts

P olicy A u th or/T eam :                                        T y p e of docu m ent:

R e v ie w o f P u b lic A d m in is tra tio n                   D e p a rtm e n ta l P ro c e d u re
In c o m e T e a m le d b y
Ia n W in to n
G e n e ra l M a n a g e r F in a n c e
A p p roved by :                                                 Date P olicy dis s em inated by
                                                                 E q u ality U nit:
L ia m O ’K a n e
A s s is ta n t D ire c to r F in a n c ia l A c c o u n tin g   2 1 O c to b e r 2 0 0 9
a n d F in a n c ia l S e rv ic e s

Date A p p roved:

2 0 O c to b e r 2 0 0 9


                         N H S CT M IS S IO N S T A T E M E N T
  To provide for all the quality of services we would ex pect for our fam ilies
                                  an d ourselves
  Operational Procedure




Invoicing and Debt Control
 Private Patients Charges
                   NORTHERN HEALTH AND SOCIAL CARE TRUST


                               INV OICING AND DEB T CONTROL
                                PRIV ATE PATIENTS CHARG ES


                                                 CONTENTS




                                                                                           Page

Introduction .........................................................................     1

Private patient identification ................................................            2

Change of status from private to NHS ................................                      3

Amenity accommodation.....................................................                 3

Private patient invoicing ......................................................           3

Credit control procedure .....................................................             4

Review ................................................................................    6

Advice .................................................................................   6




Draft Invoicing and Debt Control Procedure - Private PatientsCharges
PRIVATE PATIENT CHARGES


Introduction


Private practice in health service hospitals in Northern Ireland is conducted in accordance
with Articles 31 and 32 of the H& PSS (NI) Order 197 2 (Appendix 1 – Articles 31 & 32
H &P S S (N I) O rder 19 7 2).

The provision of accommodation and services for private patients must not interfere with
the Trust’s duty to provide health service accommodation and services, or operate to the
disadvantage of those who are, or wish to become, Health Service patients.


Private patient fees are structured in the follow ing w ay:

   a) The Consultant/Professional will charge for his/her time and ex pertise.
      This is a private arrangement between the patient and practitioner.
      The Trust has no part in the setting of these charges.

   b) Where Trust accommodation, facilities or eq uipment have been used, the Trust will
      mak e a charge. These charges are set under guidance from The Department of
      Health Social Services and Public Safety and are reviewed on 1st April annually.
      Charges are based on the average cost of treating patients both private and NHS.
      While every effort will be made to provide satisfactory accommodation and
      services, the hospital is not committed to provide a particular standard of
      accommodation or service therefore charges will not be adjusted.

   c) The patient may change to Health service status following the initial episode of
      private care if they so choose.

   d) Where a patient is paying for private treatment through a private health insurance
      policy, it is the responsibility of the patient to mak e the claim. Trust invoices will be
      issued to the patient for payment. The Trust will NOT issue invoices direct to
      insurance companies on behalf of patients.

   e) All private patient charges are outside the scope of V AT.




Invoicing and Debt Control Procedure - Private Patients Charge                                 1
1.      Private Patient Identification

1.1     Consultants have a contractual obligation to co-operate with Trust management by
        identifying their patients’ private status, or any change in status. Consultants
        should further ensure that private patients have been given details and other
        information necessary for them to understand the financial liability they are entering
        into. Trust management depends on the co-operation of hospital consultants in
        identifying private patients so that all private in-patient, outpatient and day patient
        attendances, treatments and procedures may be recorded and all hospital charges
        may be recovered in full.

1.2     Patients admitted under Article 31(2) and those treated under Article 32 must be
        told that the hospital charges are separate from the professional fees charged by
        the consultant or consultants.

1.3     It is essential to identify private patients at the outset of treatment. It is
        responsibility of the consultant with primary care for the patient to identify their
        private status by completion of the Patient Identification Form PNB 1 (Appendix 2 –
        PNB 1).

1.4     The patient must be provided with Information to Private Patients leaflet (Appendix
        3).

1.5     The patient must be asked to read and sign an U ndertaking to Pay form. PNB 3 (In
        -patient) or PNB 4 (Out-patient/Daycase). It is important that the signature is
        obtained BEF ORE private treatment is provided as these forms will be used as
        evidence in court if a case is taken against the patient in the future for non payment
        of private fees. (Appendix 4 - PNB 3 Appendix 5 – PNB 4 ).

1.6     The completed PNB 1 & PNB 3/4 should then be sent by the Consultant to the
        private patient officer.

1.7     In the case of a private out-patient where additional technical or paramedical
        services or equipment e.g. X -ray E CG or Laboratory are used in their private
        treatment the department concerned will complete a private out-patient
        charges/consultant/technical/paramedical service form PNB 5 and forward to the
        private patient officer. (Appendix 6 – PNB 5 )

1.8     In the case of a private in-patient no charge is made for technical or paramedical
        services or equipment. They will be charged for accommodation and use of
        operating theatre only. In the case of a private daycase, a charge will be made for
        technical or paramedical services used.

1.9     The private patient officer will check that all forms are correctly completed. If any
        PNB 3/4 forms have not been signed, the private patient officer will issue the form
        to the patient’s address and hold the paperwork until it is returned signed by the



Invoicing and Debt Control Procedure - Private Patients Charge                                  2
        patient. Then the details are listed on a notification to finance dept form PNB 6 (In-
        patient) or PNB 7 (Out-patient) and forward with the backup to the Finance Dept for
        invoicing. (Appendix 7 – PNB6 Appendix 8 – PNB7)

2.      Change of status from Private Patient to NHS

2.1     The patient may change status from private to NHS for subsequent appointments if
        they wish by completing a change of status form PNB 9. (Appendix 9 – PNB 9).
        The Trust must ensure that the full cost of private treatment is based on the
        application of appropriate costing techniques. A fundamental review of costs
        should be undertaken periodically.

2.2     A change of status from private to NHS must be accompanied by an assessment,
        by the appropriate consultant, of the patient’s clinical priority for treatment as a
        Health Service patient.

2.3     It is important that any private patient who wishes to become an NHS patient
        should gain no advantage over other Health Service patients by so doing.


3.      Amenity Accommodation

3.1     Amenity beds are defined as accommodation made available for non-private in-
        patients who give an undertaking to pay charges as determined by the Trust, for
        accommodation in a single room, which is not for the time being required by any
        patient on medical grounds. The ward clerk will ask the patient to sign a private
        inpatient not paying separately for private treatment by medical/dental staff form
        PNB2. (Appendix 10 – PNB2) and then forward to the Private Patient Officer
        (Antrim Hospital only).

3.1     The private patient officer will complete a PNB 6 form and forward to finance for
        invoicing.


4.      Private Patient Invoicing – Finance Dept

4.1     The finance officer receives the PNB6/7 with attached PNB1/2/3/4/5 as appropriate
        from the private patient officer.

4.2     Each form is coded and priced according to the Trusts financial coding book and
        private patient price list.

4.3     The debtors billing system is checked for an existing customer number. If a
        number exists this is written on the PNB1 form. If any additional information is
        provided on the PNB1/3/4, which is not held on the Debtors Billing System (DBS),
        the system is updated e.g. insurance details, changes of address etc.



Invoicing and Debt Control Procedure - Private Patients Charge                                 3
4.4.    If no customer number exists for the patient a new number is created on the DBS
        under the Debtors Ledger customer file maintenance program. Customer numbers
        are alpha numeric taking the first letter of the patients surname followed by the
        next available number in the customer number book. The new number and
        customer details are entered in the customer number book.

4.5     The following details are held on the DBS customer file maintenance program.
               Customer number
               Customer name
               Customer address with postcode
               Insurance details (if applicable)
               Access key (first 5 letters of surname for easy system search)
               Cost centre
               Credit letter group (2 groups: insurance policy holders & non-policy holders)

4.6     When all customer numbers are identified a batch of invoices can be entered onto
        the DBS under the DBS Service invoicing program. Each batch is given a batch
        number Y Y /MM/NO by the system. This is entered in the batch book. As each
        invoice is produced the invoice number is written on the backup documentation
        and the PNB6/7. If insurance details are held for the patient, the policy number
        and name of the insurance company are typed onto the invoice to assist the
        insurance company when processing the patients claim.

4.7      When the batch is complete the invoices are printed and checked. (Appendix 11 –
         Inv o ice) The top copy of the invoice (white copy) is issued to the patient’s home
         address. The other copies (blue/yellow copies) are attached to the PNB1/2/3/4/5
         as appropriate and filed in invoice number order. The PNB6/7 is filed in a
         separate file. At the end of each day the batch reports are printed and filed in
         batch number order.


5.      Credit Control Procedure – Private Patient Fees

5.1     The Trust is responsible for recovering all appropriate charges from private
        patients. The aim is to ensure that income is collected promptly and accounted for
        in full.

5.2     Credit Control for private patients is split into two categories

         a.     Private patients paying fees through a private health insurance policy.
         b.     Private patients paying fees personally.

        This is to allow sufficient time for the patient to make their claim and their insurance
        company to process it.




Invoicing and Debt Control Procedure - Private Patients Charge                                4
5.3                           a                                                       b

                       Private Patients                                    Private patient paying
                   claiming fees through a                                    fees personally
                   private health insurance
                            policy



                    28 days overdue ins                                   28 days overdue letter 1
                    letter 1 Appendix 12                                       Appendix 14




                    42 days overdue ins                                   42 days overdue letter 2
                    letter 2 Appendix 13                                       Appendix 15




                   56 days overdue letter 2
                        Appendix 15


                                                     14 days after final letter
                                                        Court Application
                                                          Appendix 16



                                      21 days after court case                              14 days after letter 4
                                        letter 4 Appendix 17                           Enforcement of J udgement 1
                                                                                        (If economical to continue)
                                                                                                Appendix 18




5.4     Letters are produced in duplicate by the DBS as per the credit letter group held on
        the individual customer file.

5.5     An aged debt report is printed from the DBS and each letter is marked on the
        report. The top copy is issued to the patient and the 2nd copy is filed by the finance
        dept.

5.6     If no reply is received from the patient the procedure at 5.3 is followed. If the
        patient contacts the finance dept with a reasonable explanation for non-payment,
        the process will be put on hold until the problem or query can be resolved.

5.7     All telephone calls/queries etc are recorded on the aged debt report for information.

5.8     On a monthly basis, a senior officer examines the aged debt report to ensure every
        effort is being made to recover debt due to the Trust.




Invoicing and Debt Control Procedure - Private Patients Charge                                                        5
5.9     Any agreements to pay by instalments must be requested in writing by the patient
        and agreed by the Trust. Default on agreed forms will make this agreement null
        and void.


6.      Review

6.1     This procedure will be kept under review, and its operation and effectiveness will
        be examined on an annual basis and revised if appropriate.


7.      ADVICE

7.1     This procedure was drawn up by members of the RPA Income Group. If you
        require further advice or assistance, please contact one of the following members
        the financial services staff.


         Name                      Email address                              Telephone
                                                                              number
         Rhonda Hilditch           rhonda.hilditch@ northerntrust.hscni.net   2563 5387
         Margaret Knox             margaret.knox@ northerntrust.hscni.net     2563 5432
         Evelyn Stephens           evelyn.stephens@ northerntrust.hscni.net   2563 5696




Invoicing and Debt Control Procedure - Private Patients Charge                               6
                                          Listing of Appendices


      Appendix 1                   Article 31 and 32 H&PSS (NI) Order 1972
      Appendix 2                   PNB1 - Patient identification form
      Appendix 3                   Information to private patients leaflet
      Appendix 4                   PNB3 – Undertaking to pay form (In-patient)
      Appendix 5                   PNB4 – Undertaking to pay form (Out-patient)
      Appendix 6                   PNB5 – Technical Services form
      Appendix 7                   PNB6 – Notification to fin form (In-patient)
      Appendix 8                   PNB7 – Notification to fin form (Out-patient)
      Appendix 9                   PNB9 – Change of status form
      Appendix 10                  PNB10 – Undertaking to pay form (Amenity)
      Appendix 11                  Invoice
      Appendix 12                  Debt letter Insurance 1
      Appendix 13                  Debt letter Insurance 2
      Appendix 14                  Debt letter 1
      Appendix 15                  Debt letter 2
      Appendix 16                  Court Application form
      Appendix 17                  After Court reminder letter
      Appendix 18                  Enforcement of judgements form 1




Invoicing and Debt Control Procedure - Private Patients Charges
                                                                                                                      Appendix 1
                                                                                                                        (Page 1 of 2)
HEALTH & PERSONAL SOCIAL SERVICES (NI) ORDER 1972


Accommodation and treatment at hospitals of persons as priv ate resident patients

Article 31.-

(1)     If th e m in is try is s a tis fied th a t it is rea s o n a b le to d o s o , it m a y s u b ject to th e p ro v is io n s o f
        th is Article, a u th o ris e a cco m m o d a tio n a t a h o s p ita l v es ted in it to b e m a d e a v a ila b le, to
        s u ch a n ex ten t a s it m a y d eterm in e, fo r res id en t p a tien ts w h o u n d erta k e, o r in res p ect o f
        w h o m a n u n d erta k in g is g iv en , to p a y s u ch ch a rg es a s th e M in is try m a y , in a cco rd a n ce
        w ith th e fo llo w in g p ro v is io n s o f th is Article, d eterm in e, a n d th e M in is try m a y reco v er th o s e
        ch a rg es .

(2 )    T h e M in is try m a y a llo w a cco m m o d a tio n & s erv ices to w h ich a n a u th o ris a tio n u n d er
        p a ra g ra p h (1) rela tes to b e m a d e a v a ila b le in co n n ectio n w ith th e trea tm en t, in p u rs u a n ce o f
        a rra n g em en ts m a d e b y a m ed ica l o r d en ta l p ra ctitio n er s erv in g , w h eth er in a n h o n o ra ry o r
        p a id ca p a city , o n th e s ta ff o f a h o s p ita l, o f p riv a te p a tien ts o f th a t p ra ctitio n er a s res id en t
        p a tien ts .

(3)     T h e M in is try m a y , fo r th e p u rp o s e o f d eterm in in g ch a rg es to b e p a id u n d er p a ra g ra p h (1)
        cla s s ify th e h o s p ita ls a n d m a y , in th e ca s e o f ea ch cla s s , d eterm in e, in res p ect o f ea ch
        p erio d o f tw elv e m o n th s b eg in n in g w ith th e 1s t M a y firs t fa llin g a fter th e d a te o n w h ich th e
        d eterm in a tio n is m a d e, th e ch a rg es to b e p a id u n d er p a ra g ra p h (1) in res p ect o f
        a cco m m o d a tio n & s erv ices p ro v id ed d u rin g th a t p erio d a t a h o s p ita l fa llin g w ith in th a t
        cla s s ; a n d , in d eterm in in g s u ch ch a rg es in res p ect o f a p erio d , th e M in is try –

        (a )      s h a ll h a v e reg a rd , s o fa r a s rea s o n a b ly p ra ctica b le, to th e to ta l co s t (ex clu s iv e o f
                  co s ts a p p ea rin g to it to b e p ro p erly a ttrib u ta b le to ca p ita l a cco u n t) w h ich , b y
                  referen ce to fa cts k n o w n to it a t th e tim e o f th e d eterm in a tio n , it is es tim a ted w ill b e
                  in cu rred d u rin g th a t p erio d in th e p ro v is io n fo r res id en t p a tien ts o f s erv ices a t
                  h o s p ita ls fa llin g w ith in th a t cla s s ; a n d

        (b )      m a y in clu d e in a n y s u ch ch a rg es , in s u ch ca s es a s a p p ea r fit, s u ch a m o u n ts a s
                  a p p ea r p ro p er a n d rea s o n a b le to b e in clu d ed b y w a y o f co n trib u tio n to ex p en d itu re
                  a p p ea rin g to it to b e p ro p erly a ttrib u ted to ca p ita l a cco u n t.

(4 )    T h e M in is try m a y , u n d er p a ra g ra p h (3), d eterm in e d ifferen t ch a rg es fo r d ifferen t
        a cco m m o d a tio n a n d fo r d ifferen t s erv ices a n d in rela tio n to d ifferen t circu m s ta n ces .


(5 )    T h e M in is try m a y a llo w s u ch d ed u ctio n fro m th e a m o u n t o f a ch a rg e d u e b y v irtu e o f a n
        u n d erta k in g g iv en u n d er th is Article b y , o r in res p ect o f, a p a tien t a s it th in k s p ro p er –

        (a )      in res p ect o f trea tm en t g iv en to th e p a tien t u n d er p a ra g ra p h (2 ); a n d


Invoicing and Debt Control Procedure - Private Patients Charges
                                                                                        Appendix 1
                                                                                         (Page 2 of 2)

        (b)      in respect of any period during which the accommodation to which the undertaking
                 relates is temporarily vacated by the patient.


(6 )    N othing in this Article shall prevent accommodation from being made available for a
        patient other than one mentioned in paragraph (1), if the use thereof is needed more
        urgently for him on medical grounds than for a patient so mentioned and other suitable
        accommodation is not available


Accommodation and treatment at hospitals of persons as private non-resident patients

Article 32.-

(1)     If the Ministry is satisfied that it is reasonable to do so, it may authorise accommodation
        and services to a hospital vested in it to be made available to such extent as it may
        determine, in connection with the treatment, in pursuance of arrangements made by a
        medical or dental practitioner serving, whether in an honorary or paid capacity, on the staff
        of any such hospital of private patients of the practitioner otherwise than as resident
        patients, being patients who undertake, or in respect of whom an undertaking is given, to
        pay, in respect of the provision of any such accommodation and any such services, such
        charges as the Ministry may determine, and the Ministry may recover those charges.

(2)     The Ministry may, under paragraph (1), determine different charges for different
        accommodation and for different services and in relation to different circumstances.

(3)     Accommodation and services shall not be made available under paragraph (1) so as to
        prejudice persons availing themselves of services at the hospital otherwise than as private
        patients.




Invoicing and Debt Control Procedure - Private Patients Charges
                                                                                                                                    Appendix 2
                                                                                                                                          PNB1
                                                                                                                PRIVATE PATIENT IDENTIFICATION

Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Address: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

________________________________________________                                                                   P/P Ref: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

________________________________________________                                                                   Unit No: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _


is to be                      Admitted to ward:                                                       As a Private Patient on:
  was                         --------------------------------------------------------------------------------------------------------------------------------------------
                              (Single Room/Other Accommodation)

                           NB Please classify each case for charging purposes by tick ing the appropriate box

                           DAY CASE SURGERY                                                           IN-PATIENT SURGERY

                           0-10 Minutes                                                                            Major

                           10-30 Minutes                                                                           Intermediate

                           More than 30 Minutes


                           Referred for a Private Out-Patient consultation in: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

                           Referred as a Private Patient for: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ on: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
                           (e.g. X-Ray, Lab Test etc)

                           NB The relevant Department to be informed of P/P by Consultant

                           Seen as a Private patient outside the Health Service and will subsequently use hospital facilities as an NHS
                           patient.

                           Referred to the Hospital for the purpose of:

                           (I)          Medico-Legal examination/report*
                           (II)         Insurance Co examination/report*
                           (III)        Emigration examination/report*
                           (IV)         Pre-employment screening/report*
                           (V)          DHSS examination/report*                                                                on: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

                           * Delete that which is not applicable

SIGNED: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (Consultant)                              Date: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _


                                                                For Use in Patient Administration Department

                Please tick as appropriate

                                           (a) Undertaking P _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Signed (or give reason why not)

                                           (b) Completed Undertaking to Accounts Dept                                Date: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _


                SIGNED: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (Private Patient Officer)          Date: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _




Invoicing and Debt Control Procedure - Private Patients Charges
                                                                                                Appendix 3
                                                                                                   (Page 1 of 2)



                             Information for Private Patients
1.      W hat is an Undertaking to Pay Form?

        You will be asked to sign this form at the commencement of your private Treatment. The form
        assures the hospital that you have requested private treatment and that you agree to settle any
        bills which are forwarded to you relating to this treatment.

2.      How many bills will I receive?

        You will receive a minimum of two bills. These will be from:

        (a)      The Hospital
        (b)      The Consultant
        (c)      The Anesthetist (If you have an operation)

        You may also receive bills from:

        (I)      Laboratory
        (II)     Radiology

        These will be from Consultants who reported on any tests/x-rays which you have.

3.      How are these bills calculated?

        The Consultants bills will be a private arrangement between him/her and yourself.
        The hospital does not negotiate these bills. The hospital will charge the following:

        Accommodation for a Consultation                   £ XX.XX
        (If the consultation took place in the Hospital Consulting Room)

        Single Room cost per night                           £ XXX.XX
        Other accommodation cost per night                   £ XXX.XX

        Day Procedure Accommodation
        Cost per day                                         £ XX.XX

        Amenity Accommodation                                £ XX.XX

        The tariff is exclusive of charges for operations. It does however include all costs associated with
        accommodation, drugs, dressings, diagnostic tests and administration during an inpatient stay.
        Out-patients will be charges for diagnostic tests such as lab tests, ECG etc. If you require specific
        prices for these please contact the Finance Department.


                       Supplementary Charges for Operative Procedures
The above tariffs exclude theatre charges for in-patients and day cases, for which the following
supplementary charges will apply:




Invoicing and Debt Control Procedure - Private Patients Charges
                                                                                                Appendix 3
                                                                                                  (Page 2 of 2)
Type of Operation                  Supplementary Charge

                                   In-Patient                Out-Patient

Minor                              £XX.XX                    £XX.XX                 0-10 Minutes
Intermediate                       £XX.XX                    £XX.XX                 10-30 Minutes
Major                              £XX.XX                    £XX.XX                 More than 30 Minutes


4.      How do I settle my Bills?

        If you are not covered by medical insurance, you should settle your accounts by return by
        forwarding a cheque or postal order to the address on your invoices, or by using Visa, Access or
        MasterCard.
        If you are covered by medical insurance, you need to do the following:

        (a)       Inform your Medical Insurance Company that you are being treated ay hospital. You will
                  need to tell them why, so that they can check that this particular diagnosis is covered by
                  your policy.

        (b)       Ask your Medical Insurance Company to forward a claim form to you. You should bring
                  this claim form to the hospital with you.

        (c)       Ask your Consultant to complete the Claim Form and return it to you.

        (d)       Forward all bills with your claim form to your Medical Insurance Company. They will then
                  settle directly with the hospital and Consultants.

        (e)       Your Medical Insurance Company will normally send you a remittance advice, informing
                  you that your bills have been settled.

5.      What do I do if I receive a late Invoice?

        If an invoice arrives after you have forwarded other invoices and claim form to your Medical
        Insurance Company, you should send the late invoice to your Medical Insurance Company with a
        covering note explaining that this bill has arrived late. You should state your policy number on this
        letter, your dates of treatment and the Consultant in charge of your care. You will not normally be
        penaliz ed for submitting late invoices.

6.      What do I do if I receive a reminder letter?

        The hospital expects to receive payment for your treatment as soon as possible after the issue of
        an invoice.

        A reminder letter will be furnished if an invoice remains outstanding twenty-eight days after issue.
        We appreciate that delays may occur this being the case, please contact the Finance Department
        on receipt of your reminder letter.

              Please note that failure to make payment may result in legal action being taken.

7.      Who should I contact if I have a query?

        You should contact staff in the Cash Office at XXXXXXXXXXX Hospital if you have a query.
        The telephone number is as follows:

        XXXXXXXXXXXXX


Invoicing and Debt Control Procedure - Private Patients Charges
                                                                                                 Appendix 4
                                                                                             PNB3 (Page 1of 2)
                                                                             PRIVATE INPATIENTS PAYING FOR
                                                                     MEDICAL AND DENTAL STAFF SEPARATELY
                                                                                                                              Article 31
Private Patient Reference No: ________________________

Hospital: _________________________________________

                                      UNDERTAK ING TO PAY HOSPITAL CHARGES
                          IN RESPECT OF ACCOMMODATION AND SERVICES AS A PRIVATE PATIENT
              (Before filling in this form you should read the notes overleaf and information leaflet for private patients)
a.      I__________________________________________________________________________________________________

        of ________________________________________________________________________________________________

        undertake to pay Northern Health & Social Care Trust in respect of accommodation and services

b.      provided for me                                                      ____________           (Patient Unit No___               )

c.      as a private resident patient at the __________________________________________________Hospital

        such charges as may from time to time be determined under Article 31 of the Health and personal Social Services (NI)
        Order 1972

        Date of admission _________________________________Date of discharge____________________________________


d.      I agree to pay for a single room/other accommodation

e.      I understand that such charges DO NOT include any payment for professional medical and dental services under which

        (I am) (____________________________________________________________________________is being) treated.

f.                   S p lme tr C a g s
                      u pe nay h r e                                      N.B. The daily charge to the Trust is £ … … … … . for
                                                                          a single room and £ … … … … … for other
          Mio O eain
           n r p rto                   £                                  accommodation. This is ADDITIONAL to any
                                                                          professional fees you may be paying privately to a
          I tr daeO eain £
          neme it p rto                                                   medical or dental practitioner, or any other practitioner.
                                                                          If you have any questions please ask.
            jr p rto
          Mao O eain                   £

g.      TO BE COMPLETED BY PATIENT OR PATIENTS REPRESENTATIVE
        I. Are you a member of a private Medical Insurance Company                  YES                    NO

        II. If YES, what is the name of your insurance Company?

        _____________________________________________________________________________________________

        _____________________________________________________________________________________________

        III. Please state your registration No: ___________________________________________

        IV. If NO          Cash            Cheque               Other               Please specify _________________________

        I confirm I have read the contents of this form. I the Patient (or Patients Representative) have confirmed that I
        understand the ramifications of signing.

        SIGNED: ___________________________________________________Date: _______________________________
h.      WITNESSED BY
        SIGNED: ___________________________________________________Date: _______________________________

        When you have filled in the form of undertaking all copies should be returned to The Private Patient Officer, Medical
        Records Department. An undertaking to pay charges must be completed before a person can be admitted as a Private
        Patient.


Invoicing and Debt Control procedure- Private Patients Charges
                                                                                                                        Appendix 4
                                                                                                                          (Page 2 of 2)




                                                  GUIDE TO COMPLETION


a & g These forms should be completed by the patient of by a representative who is willing to accept responsibility for the charges.

b & e This should be the name of the patient if he or she is not completing the form.

b.    The Patient Unit Number will be completed by Medical Records Dept.

c.     Name of Hospital Administration Dept will complete date of admission & discharge.




                                                               NOTES

1. The hospital charges are fixed by the Department of Health & Social Services and are revised annually. They are national
charges based on the average cost of providing the accommodation or services to all patients, Private and Health Service. The
charges cannot be adjusted to take account of differences in accommodation or services. While payment of the charge does not
commit the Hospital to provide a particular standard of accommodation or service every effort will be made to ensure that the
accommodation and services are satisfactory. You should endeavour to pay any outstanding sums as soon as possible after your
treatment. However if an insurance scheme is responsible for payment please give the appropriate details to the Finance Dept.


2. Professional fees may be charged by a patient’s own medical or dental practitioner and you may agree to make similar private
arrangements for professional services by other practitioners at the hospital such as a pathologist, radiologist or anaesthetist. This is
a private matter between you and the practitioner concerned. The hospital is not involved in fixing these fees and if you have any
queries you should discuss them with the doctor or dentist concerned. It is advisable to find out how much the fees are likely to be in
advance.


3. Hospital charges are reviewed each 1 April and any changes will come into effect on that day.


4. Charges will be made for each attendance as a private patient and it is expected that you will continue to be treated privately for
the whole of the diagnosis and treatment of the condition for which you are attending the hospital. If you wish to change to Health
Service status, (following this episode of private care) you must apply to the Health Trust.


5. The hospital will do its best to make your own or the patients time here as comfortable and as pleasant as possible. If you should
have any complaints please tell the Sister or other person in charge of the hospital Department or ask to speak to the Hospital
Administrator.




Invoicing and Debt Control procedure- Private Patients Charges
                                                                                                            Appendix 5
                                                                                                        PNB4 (Page 1 of 2)
                                                                                                 PRIVATE OUTPATIENTS
                                                                                                       AND DAY CASES
                                                                                                                           Article 31
Private Patient Reference No: ________________________

Hospital: _________________________________________

     UNDERTAKING TO PAY CHARGES IN RESPECT OF HOSPITAL TREATMENT, ACCOMMODATION AND SERVICES AS A
            PRIVATE NON-RESIDENT PATIENT WHO IS PAYING MEDICAL AND DENTAL STAFF SEPARATELY
         (Before filling in this form you should read the notes overleaf and information leaflet for private patients)
a.       I__________________________________________________________________________________

         of _________________________________________________________________________________

         undertake to pay Northern Health & Social Care Trust in respect of accommodation and services

b.       provided for me                                                                 (Patient Unit No                  )

c.       as a private resident patient at the __________________________________________________Hospital

         such charges as may from time to time be determined under Article 31 of the Health and personal Social
         Services (NI) Order 1972

         Date of first consultation/day treatment/treatment ______________________________________________

         I understand that I am liable to pay charges for Outpatients diagnostic procedures, treatment and appliances, which may be
         requires as part of attendance as a private non-resident patient at this hospital.

d.       I also understand that such charges do not include any payment for professional medical and dental services under which

         (I am) (____________________________________________________________________is being) treated.

e.       TO BE COMPLETED BY PATIENT OR PATIENTS REPRESENTATIVE

         I. Are you a member of a private Medical Insurance Company                      YES                    NO

         II. If YES, what is the name of your insurance Company?

         ________________________________________________________________________________________

         ________________________________________________________________________________________

         III. Please state your registration No: ___________________________________________

         IV. If NO         Cash           Cheque              Other             Please specify _________________________


         I confirm I have read the contents of this form. I the Patient (or Patients Representative) have confirmed that I
         understand the ramifications of signing.

         SIGNED: _____________________________________________Date: _______________________________

f.       WITNESSED BY

         SIGNED: _____________________________________________Date: _______________________________

         When you have filled in the form of undertaking all copies should be returned to The Private Patient Officer, Medical
         Records Department. An undertaking to pay charges must be completed before a person can be admitted as a Private
         Patient.



Invoicing and Debt Control procedure- Private Patients Charges
                                                                                                                        Appendix 5
                                                                                                                          (Page 2 of 2)




                                                  GUIDE TO COMPLETION


a & g These forms should be completed by the patient of by a representative who is willing to accept responsibility for the charges.

b & e This should be the name of the patient if he or she is not completing the form.

b.    The Patient Unit Number will be completed by Medical Records Dept.

c.     Name of Hospital Administration Dept will complete date of admission & discharge.




                                                               NOTES

1. The hospital charges are fixed by the Department of Health & Social Services and are revised annually. They are national
charges based on the average cost of providing the accommodation or services to all patients, Private and Health Service. The
charges cannot be adjusted to take account of differences in accommodation or services. While payment of the charge does not
commit the Hospital to provide a particular standard of accommodation or service every effort will be made to ensure that the
accommodation and services are satisfactory. You should endeavour to pay any outstanding sums as soon as possible after your
treatment. However if an insurance scheme is responsible for payment please give the appropriate details to the Finance Dept.


2. Professional fees may be charged by a patient’s own medical or dental practitioner and you may agree to make similar private
arrangements for professional services by other practitioners at the hospital such as a pathologist, radiologist or anaesthetist. This is
a private matter between you and the practitioner concerned. The hospital is not involved in fixing these fees and if you have any
queries you should discuss them with the doctor or dentist concerned. It is advisable to find out how much the fees are likely to be in
advance.


3. Hospital charges are reviewed each 1 April and any changes will come into effect on that day.


4. Charges will be made for each attendance as a private patient and it is expected that you will continue to be treated privately for
the whole of the diagnosis and treatment of the condition for which you are attending the hospital. If you wish to change to Health
Service status, (following this episode of private care) you must apply to the Health Trust.


5. The hospital will do its best to make your own or the patients time here as comfortable and as pleasant as possible. If you should
have any complaints please tell the Sister or other person in charge of the hospital Department or ask to speak to the Hospital
Administrator.




Invoicing and Debt Control procedure- Private Patients Charges
                                                                                           Appendix 6
                                                                                               PNB5
                                                                 CATEGORY II WORK/PRIVATE OUTPATIENT
                                                                     CHARGES/CONSULTANT/TECHNICAL/
                                                                               PARAMEDICAL SERVICES
Private Patient Ref No: _______________________

__________________________________________                         Hospital: ___________________________________


         This form to be completed by a member of a paramedical department before treating a private out-patient


Name of Patient: ________________________________                  Patient unit number: __________________________

Address of Patient: _______________________________________________________________________________


Department          (please tick box)        Type of Treatment/Examination/Units        Unit Cost £        Total £

Radiology


Laboratory Tests


Pathology Investigations


Physiotherapy


Occupational Therapy


Dental


Opthalmic


Other Procedures




The above tests were done at the request of: ___________________________________________________________


Signed: _______________________________ Grade: ____________________________ Date: _________________


On completion of form please send copies to:        Yellow Copy - Finance Dept – Via Medical Records

                                                    Pink Copy    - Private Patient Officer

                                                    White Copy - Retailed for Consultant/Technical/Paramedical Officer




Invoicing and Debt Control procedure- Private Patients Charges
                                                                                                                      Appendix 7
                                                                                                                          PNB6


                                               NOTIFICATION TO FINANCE DEPARTMENT
                                                  PRIVATE INPATIENT DISCHARGES


Hospital: ___________________________________________________ Week Ending: _______________________________


          Name                     Unit                 Consultant    Date Of     Date of                   Remarks
                                  Number                             Discharge   Admission




Signed: ______________________                                                               On completion of form please send:-

Date: ________________________                                                               Yellow Copy – Finance Dept
                                                                                             White Copy - Private Patient Officer




Invoicing and Debt Control procedure- Private Patients Charges
                                                                                                                                            Appendix 8
                                                                                                                                                PNB7


NOTIFICATION TO FINANCE DEPARTMENT
                               PRIVATE OUTPATIENTS


Hospital: ___________________________________________________ Week Ending: _______________________________


          Name                     Unit                 Consultant             Date of             Tick if 1st*           Details Of Diagnostic
                                  Number                                     Consultation         Consultation            Tests/Treatment/Units




Signed: ______________________                                                                                     On completion of form please send:-

Date: ________________________                                                                                     Yellow Copy – Finance Dept
                                                                                                                   White Copy - Private Patient Officer
                                                            .
                                                       st
                                               * For 1 consultation only, please attach undertaking to pay form.




Invoicing and Debt Control procedure- Private Patients Charges
                                                                                      Appendix 9
                                                                                          PNB9

CHANGE OF STATUS FROM PRIVATE PATIENT TO NATIONAL HEALTH SERVICE PATIENT



I ______________________________________being a patient in/attending

___________________Ward/Unit of _______________________________________Hospital

hereby declare that I wish to cancel my Private Patient status from (date) ________________



I understand that, subject to approval, I am now a National Health Service patient.


Signed: _____________________________________

Date: _______________________________________




FOR OFFICIAL USE ONLY



    (a) I recommend that this request be approved with effect from:

             __________________


            Signed: ________________________________ (Consultant in Charge)

            Date:     ________________________________

    (b) I authorize the release of the above named patient from Private Patient status to national
        Health Service status.


        Signed: __________________________________ (Clinical Director)

        Date:     __________________________________




Invoicing and Debt Control procedure- Private Patients Charges
                                                                                          Appendix 10
                                                                                       PNB2 (Page 1 of 2)
                                                           PRIVATE INPATIENTS NOT PAYING SEPARATELY
                                                                  FOR PRIVATE TREATMENT BY MEDICAL
                                                                                   AND DENTAL STAFF
                                                                                                                          Article 31
Private Patient Reference No: ________________________

Hospital: _________________________________________

                    UNDERTAKING TO PAY CHARGES IN RESPECT OF HOSPITAL TREATMENT,
                          ACCOMMODATION AND SERVICES AS A PRIVATE PATIENT
        (Before filling in this form you should read the notes overleaf and information leaflet for private patients)
a.      I__________________________________________________________________________________

        of _________________________________________________________________________________

        undertake to pay Northern Health & Social Care Trust in respect of accommodation and services

b.      provided for me                                                                 (Patient Unit No                  )

c.      as a private resident patient at the __________________________________________________Hospital

        such charges as may from time to time be determined under Article 31 of the Health and personal Social
        Services (NI) Order 1972

        Date of Admission: _________________________ Date of Discharge: ___________________________


d.      I agree to pay for an amenity room.

        Daily Charge £ ____________

e.      TO BE COMPLETED BY PATIENT OR PATIENTS REPRESENTATIVE

        I. Are you a member of a private Medical Insurance Company                      YES                    NO

        II. If YES, what is the name of your insurance Company?

        ________________________________________________________________________________________

        ________________________________________________________________________________________

        III. Please state your registration No: ___________________________________________

        IV. If NO         Cash           Cheque              Other             Please specify _________________________


        I confirm I have read the contents of this form. I the Patient (or Patients Representative) have confirmed that I
        understand the ramifications of signing.
        SIGNED: _____________________________________________Date: _______________________________
f.      WITNESSED BY
        SIGNED: _____________________________________________Date: _______________________________

        When you have filled in the form of undertaking all copies should be returned to The Private Patient Officer, Medical
        Records Department. An undertaking to pay charges must be completed before a person can be admitted as a Private
        Patient.

                                                       662 0
Invoicing and Debt Control - Private Patients Charges 2 / / 0 8
                                                                                                                    Appendix 10
                                                                                                                       (Page 2 of 2)



                                                 GUIDE TO COMPLETION


a & b These forms should be completed by the patient of by a representative who is willing to accept responsibility for the charges.

b     This should be the name of the patient if he or she is not completing the form.

b.    The Patient Unit Number will be completed by Medical Records Dept.

c.    Name of Hospital Administration Dept will complete date of admission & discharge.




                                                             NOTES

1. The hospital charges are fixed by the Department of Health & Social Services and are revised annually. They are national
charges based on the average cost of providing the accommodation or services to all patients, Private and Health Service. The
charges cannot be adjusted to take account of differences in accommodation or services. While payment of the charge does not
commit the Hospital to provide a particular standard of accommodation or service every effort will be made to ensure that the
accommodation and services are satisfactory. You should endeavour to pay any outstanding sums as soon as possible after your
treatment. However if an insurance scheme is responsible for payment please give the appropriate details to the Finance Dept.




2. Hospital charges are reviewed each 1 April and any changes will come into effect on that day.




3. The hospital will do its best to make your own or the patients time here as comfortable and as pleasant as possible. If you should
have any complaints please tell the Sister or other person in charge of the hospital Department or ask to speak to the Hospital
Administrator.




Invoicing and Debt Control - Private Patients Charges 26/6/2008
                                                                                                             Appendix 11



                                                                VAT Registration No. GD080
Finance Dept
________________________________________________________________________________________
Invoice to:
                                                    Invoice No:

                                                                           Account No:

                                                                           Date:

                                                    Contract Ref:
_________________________________________________________________________________________

_________________________________________________________________________________________




                                                                                               OT L
                                                                                              T A
Immediate payment is requested
                                                                                               A
                                                                                              VT

                                                                                              A   N
                                                                                               MOU T
                                                                                               U
                                                                                              D E

                    Please detach this remittance advice and return with your payment to the above address
                                                REMITTANCE ADVICE
                                                                           Invoice no:
You are reminded your remittance is due by return
                                                                           Account No:
Payment may be made by crossed cheque made payable
To NH&SCT or by credit card                                                Date:

Credit card no:
                                                                                     AMOUNT
                                                                                     DUE

Expiry Date: ________________ Telephone No: _________________

Card Holders Signature: ____________________________________
                                                       /1
Invoicing and Debt Control - Private Patients Charges 1 0/2009
                                                                                                  Appendix 12



                                                                                              Cash Office, Finance

 XX/XX/XX


Xxx xxxxxxxxx
Xxxxxxxxxxxxx
Xxxxxxxxxxxxx
Xxxxxxxxxxxxx
                                                                                             Our Ref: XXXXX



Dear Sir/Madam

                          Invoice                     Dated                       Amount



I refer to the above invoice/s which remain outstanding.

According to our records you are making a claim through a Private Health Insurance
Company.

Please confirm your claim has been submitted.

Please let us know when payment can be expected.

Cheques should be made payable to Northern Health & Social Care Trust and
forwarded to The Cash Office. Braid Valley Hospital, Ballymena Co Antrim

If you require any further information please contact us.

Yours faithfully




Credit Control Officer



                          Braid Valley site, Cushendall Road, Ballymena Co Antrim BT43 6HL
                                       Tel: 028 2563 5432 Fax: 028 2563 5385
                                     E-mail: Margaret.knox@northerntrust.hscni.net



Invoicing and Debt Control - Private Patients Charges 1/10/2009
                                                                                                  Appendix 13



                                                                                              Cash Office, Finance

 Xx/xx/xx


XXXXXXXXXXXX
XXXXXXXXXXXX
XXXXXXXXXXXX
XXXXXXXXXXXX                                                                                 Our Ref: XXXXX


Dear Sir/Madam


                          Invoice                     Dated                       Amount


I refer to previous correspondence regarding the invoice/s listed above.

To date no payment has been received from your insurance company.

As this/these is/are now overdue, it would be appreciated if you would contact them
immediately and let us know when payment can be expected.

Cheques should be made payable to Northern Health & Social Care Trust and
forwarded to The Cash Office. Whiteabbey Hospital

If you require any further information please contact us.


Yours faithfully



______________
Credit Control Officer




                          Braid Valley site, Cushendall Road, Ballymena Co Antrim BT43 6HL
                                       Tel: 028 2563 5432 Fax: 028 2563 5385
                                     E-mail: Margaret.knox@northerntrust.hscni.net




Invoicing and Debt Control - Private Patients Charges 1/10/2009
                                                                                                 Appendix 14



                                          First Reminder letter


                                                      Northern Health & Social Care Trust
                                                      Financial Services
                                                      Braid Valley site
                                                      Cushendall Road
                                                      Ballymena
                                                      BT43 6HL

                                                      Phone No: 028 2563 5432
Customer Name
Customer Address                                      Customer No:                XXXXX
XXXXXXXXXXXXXX                                        Date:                       XX/XX/XX
XXXXXXXXXXXXXX
XXXXXXXXXXXXXX

Dear Sir/Madam

                 Invoice No                           Date Issued                            Amount

                 XXXXXX                               XX/XX/XX                               £0.00

According to our records the invoice(s) summarised above remains unpaid.

Please note that our invoices state, “Immediate payment is required”. Therefore
payment of the invoice(s) summarised above is now overdue.
The Trust would be grateful if you would give this matter your immediate attention.

If the invoice has been paid within the past 7 days, please ignore this reminder.

Your cooperation in this matter will be much appreciated.

Yours faithfully


_________________
Credit Control Officer




                          Braid Valley site, Cushendall Road, Ballymena Co Antrim BT43 6HL
                                       Tel: 028 2563 5432 Fax: 028 2563 5385
                                     E-mail: Margaret.knox@northerntrust.hscni.net



Invoicing and Debt Control - Private Patients Charges 1/10/2009
                                                                                                Appendix 15



                                        Second Reminder letter

                                                      Northern Health & Social Care Trust
                                                      Financial Services
                                                      Braid Valley site
                                                      Cushendall Road
                                                      Ballymena
                                                      BT43 6HL

                                                      Phone No: XXXXXXXXXXXXXX
Customer Name
Customer Address                                      Customer No:                XXXXX
XXXXXXXXXXXXXX                                        Date:                       XX/XX/XX
XXXXXXXXXXXXXX
XXXXXXXXXXXXXX

Dear Sir/Madam

                 Invoice No                           Date Issued                            Amount
                 XXXXXX                               XX/XX/XX                               £0.00

I refer to my previous reminder regarding the above invoice/s which is/are overdue for
payment to Northern Health & Social Care Trust.

If there is a reason why payment is being withheld, please provide an explanation in
writing or by e-mail and I will endeavor to help resolve the matter.

I must inform you that in the absence of a reply to this letter within 14 days the matter
will be referred to Small Claims Court.
If legal proceedings are pursued, this will affect your credit rating and your name may
appear in publications such as Stubbs Gazette.

I trust you will give this matter your immediate attention and look forward to your
cooperation.

Yours faithfully


_________________
Credit Control Officer

e-mail:
                          Braid Valley site, Cushendall Road, Ballymena Co Antrim BT43 6HL
                                       Tel: 028 2563 5432 Fax: 028 2563 5385
                                     E-mail: Margaret.knox@northerntrust.hscni.net




Invoicing and Debt Control - Private Patients Charges 1/10/2009
                                                                                         Appendix 16
                                                                                              (Page 1 of 2)
                                                 Form 125
                                              Order 26, Rule 5
                           NOTICE OF APPLICATION
                             FOR A SMALL CLAIM
                                                                                     For Office Use Only
                                                                                     Claim No.

                                                                                     Liquidated/Unliquidated

Part A
Applicant:                                              Respondent:
Full name and postal address, postcode and e-           Full name and postal address,
mail address (if appropriate)                           and e-mail address (if appropriate)
In BLOCK CAPITALS                                       In BLOCK CAPITALS
Northern Health & Social Care Trust
Financial Services Department
Cushendall Road
Ballymena
Co Antrim
BT43 6HL
Take notice that I, the above and named applicant, intend to apply to the Small Claims Court at
Ballymena Small Claims Court        for a decree in respect of:-

                         My claim for     £

                         Interest *       £

                         The court fee    £

                         Total            £

Only include a figure if you wish to claim interest and you have given details of the rate and
the period covered.

Please describe in simple terms details of your claim:- also include the date the debt arose and, if
interest is claimed, the amount, rate and period covered.




Invoicing and Debt Control - Private Patients Charges 1/10/2009
                                                                                         Appendix 16
                                                                                            (Page 2 of 2)
Statement of Truth

I believe that the facts stated in this form are true.


Full Name                                                Position or Office
                                                         Held
                                                         (if signing on behalf of firm or company)
Signed

Date




Part B
            TO BE COMPLETED BY THE SMALL CLAIMS COURT OFFICE


This application will be dealt with at __________________________ Court Office.

If you wish to dispute this claim or issue a counterclaim please read the enclosed information
leaflet and lodge a notice of dispute and/or counterclaim with the above court office.

If you wish to accept liability for this claim please read the enclosed information leaflet and
lodge a notice of acceptance of liability with the above court office.

If you intend to dispute this claim, issue a counterclaim or accept liability then you must
lodge the appropriate form with the above court office no later than
___________________________.

                                        WARNING
 If you intend to dispute the case or issue a counterclaim and you fail to reply to this
   application by the date above a decree may be issued against you without further
                                   correspondence.




Signed: ___________________________
            Chief Clerk

Date: _______________________




Invoicing and Debt Control - Private Patients Charges 1/10/2009
                                                                                                        Appendix 17


                                                                                                        Credit Control

    XX/XX/XX

X   X   X   X   X   X   X   X   X
X   X   X   X   X   X   X   X   XX
X   X   X   X   X   X   X   X   XX
X   X   X   X   X   X   X   X   XX
                                                                                            Our ref:    XXXXX
Dear Sir/Madam

RE                  Small Claims Court – X X /X X X X X
                    NH& SCT – V – X X X X X X X X X X

Please take notice that on XX/XX/XX at Belfast Small Claims Court the District Judge
awarded £XX.XX to this Trust in respect of outstanding debt. Given that no effort has
been made to settle this amount, I must inform you that if payment is not received within
7 days of the date of this letter, I will instruct the Enforcement of Judgements Office to
collect this amount plus interest and further costs.
Their collection methods include:

Attachment of earnings (instruction to your employer to deduct this amount from your
pay).
Seizure of assets (items of value).
Charge on land or property.
Direct deduction from bank account.

The use of these methods will result in additional costs and consequences in relation to
personal credit worthiness.

Full payment within 7 days will negate the need for this action.
Cheques should be made payable to Northern Health & Social Care Trust and
forwarded to the Cash Office, Braid Valley site, Cushendall Road, Ballymena Co Antrim
BT43 6HL.

I look forward to receiving your payment.


Yours faithfully


____________
Credit Control



                                     Braid Valley site, Cushendall Road, Ballymena Co Antrim BT43 6HL
                                                  Tel: 028 2563 5432 Fax: 028 2563 5385


Invoicing and Debt Control - Private Patients Charges 1/10/2009
                                    E-mail: Margaret.knox@northerntrust.hscni.net




Invoicing and Debt Control - Private Patients Charges 1/10/2009
                                                                                                      Appendix 18
                                        FORM 1 (to be submitted in duplicate)
                                                                                                             Rule 6(1)
                        NOTICE OF INTENT TO ENFORCE A MONEY J UDGEMENT
                   J UDGEMENTS ENFORCEMENT (NORTHERN IRELAND) ORDER 1981

                                                        BETWEEN

        NAME/ADDRESS OF DEBTOR/RESPONDENT                          NAME/ADDRESS OF
                                                                   CREDITOR/APPLICANT

                                                                   NORTHERN HEALTH & SOCIAL CARE TRUST
                                                                   FINANCIAL SERVICES DEPARTMENT
                                                                   BRAID VALLEY SITE, CUSHENDALL ROAD
                                                                   BALLYMENA BT43 6HL

To:
of:

TAKE NOTE that you owe the Creditor/Applicant the sum of £         together with interest at the rate of 8% per annum
(if judgement is greater than £200.00) which is the amount due on foot of a judgement given against you in the above
matter and a copy of which is attached.

YOU HAVE 10 DAYS from the date of this notice within which to pay that amount at the * address given below. If you
do not pay proceedings will be taken to enforce the judgement against you.

 REQ UISITION
                                                                  th
The Chief Enforcement Officer, Enforcement of Judgements Office, 6 Floor, Bedford House, Bedford Street, Belfast,
BT2 7FD. Please issue and serve the above Notice of Intent to proceed
on
At
which is the present address of the
said
 To the best of my/our knowledge, information and belief:

                       APPLICANT/DULY AUTHORISED PERSON/APPLICANTS SOLICITOR
NAME:      NORTHERN HEALTH & SOCIAL CARE TRUST

ADDRESS: * FINANCE DIRECTORATE, BRAID VALLEY SITE, CUSHENDALL ROAD, BALLYMENA

SIGNED:                                                           DATED:

Date of Service:                                     This date will be completed by EJ O

                                                  ADVICE TO DEBTOR
A notice of intention to proceed for enforcement of the above/attached Judgement has now been issued through this
Office and is herewith served on you pursuant to Rule 7 of the Judgement Enforcement Rules 1981.
If you pay the full amount set out on the above/attached Notice within 10 days the matter will be at an end. If
payment is delayed beyond 10 days and the creditor/applicant lodges an application for full enforcement, you
will be required to pay an additional £20.00 for the issue of this Notice AND the costs and expenses of an
application for full enforcement.
As soon as the creditor applies to the Office for enforcement a custody warrant will issue against all your goods. This
means that your goods will come under the control of the Office and it is then an offence, punishable by a fine not
exceeding £400.00 or by imprisonment for a term not exceeding 6 months, or both, for you or any other person to
interfere with the goods.
Once an application for enforcement has been made the Enforcement of Judgements Office may make such orders
under the Judgements Enforcement (Northern Ireland) Order 1981 as may be necessary to ensure payment of the
amount recoverable on foot of the Judgement and your name will be published in the Register of Judgements, which
may be viewed by the public.

PLEASE NOTE THAT PAYMENT/Q UERIES SHOULD BE MADE DIRECTLY TO THE CREDITOR OR
THEIR SOLICITOR AT THE ADDRESS * GIVEN IN THE NOTICE AND NOT TO THIS OFFICE.

Invoicing and Debt Control - Private Patients Charges 1/10/2009

								
To top