Participant Information:(write in bold)
- Full Name: [Patient Name] (only include Patient Name if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise write N/A or Not Known.)
- NDIS Number: [NDIS Number] (only include NDIS Number if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise write N/A or Not Known.)
- Plan Start/End Dates: [NDIS Plan Start Date] to [NDIS Plan End Date/Reassessment Date] (only include Start Date to End Date if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise write N/A or Not Known.)
Continuing Supports:(write in bold)
- NDIS Support Item Name: [e.g., 'Community Participation'] (only include e.g., 'Community Participation' if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise write N/A or Not Known.)
- Type of Service: [e.g., 'Group', 'Individual'] (only include e.g., 'Group', 'Individual' if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise write N/A or Not Known.)
- NDIS Item Reference Number: [e.g., '01_011_0107_1_1'] (only include e.g., '01_011_0107_1_1' if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise write N/A or Not Known.)
- Units/Hours: [Number] (only include Number if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise write N/A or Not Known)
- Rate per Unit: [Rate] (only include Rate if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise write N/A or Not Known.)
- Total Cost: [Calculated Amount] (only include Calculated Amount if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise write N/A or Not Known.)
- Transportation Included: [Yes/No] (only include Yes/No if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise write N/A or Not Known.)
- If Yes, specify:
\- Transportation Type: [e.g., 'Private Vehicle', 'Public Transport'] (only include e.g., 'Private Vehicle', 'Public Transport' if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
\- Transportation Cost: [Rate or Included in Total] (only include Rate or Included in Total if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Service Timetable for Continuing Supports:(write in bold)
- Time of Day: [e.g., 'Morning', 'Afternoon', 'Evening', 'Sleepover'] (only include e.g., 'Morning', 'Afternoon', 'Evening', 'Sleepover' if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise write N/A or Not Known.)
- Frequency: [e.g., 'Weekly'] (only include e.g., 'Weekly' if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise write N/A or Not Known.)
- Duration: [e.g., '4 hours per session'] (only include e.g., '4 hours per session' if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise write N/A or Not Known.)
- Ratio of Service: [e.g., '1:1', '1:3'] (only include e.g., '1:1', '1:3' if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise write N/A or Not Known.)
- Provider: [Provider Name] (only include Provider Name if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise write N/A or Not Known.)
Single Purchases:(write in bold)
- Item Description: [e.g., 'Assistive Technology', 'Home Modifications'] (only include e.g., 'Assistive Technology', 'Home Modifications' if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise write N/A or Not Known.)
- NDIS Item Reference Number: [e.g., '01_011_0107_1_1'] (only include e.g., '01_011_0107_1_1' if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
- Quantity: [Number] (only include Number if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
- Unit Price: [Rate] (only include Rate if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
- Total Cost: [Calculated Amount] (only include Calculated Amount if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
- Provider: [Provider Name] (only include Provider Name if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise omit completely.)
Supplementary Terms:(write in bold)
- Cancellation Policy: [NDIS Notice Period] (only include Notice Period if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise write N/A or Not Known.)
- Travel Costs (if not included in transportation): [If applicable] (only include If applicable if it has been explicitly mentioned in the transcript, contextual notes or clinical note, otherwise write N/A or Not Known.)