Product & Service Order Form

PRODUCT & SERVICE ORDER FORM

Personal information of candidate placing the order

Name & Surname: / Contact no:
Physical Address: / Email:
Profession:
Date: / HPCSA no:
Or Company / Practice number:

Select current Status:

Full Membership on the Med Care Network / 1 Months complimentary Membership on the Network

Select,by leaving a ticking inside the box, next to the Products / Items / Services you would like to order from Med Care Holdings:

Tick / PRODUCTS / PUBLIC RATE / MEMBERSHIP RATE
Pertaining to your speciality field
Tick:……………………………………..
(Mention your profession / specialist field )
…………………………………………… / Medico-legal report template per profession / speciality field
(Basic standard template) / R5000 / R3000
For occupational Therapists
Report template – Ortho Medico legal / R1500 / R800
Report template – TBI Medico legal / R1500 / R800
Report template – Peads Medico legal / R1500 / R800
FCE Report Template – Ortho client / R1500 / R800
FCE Report Template – Psych client / R1500 / R800
FCE Report Template – Cognitive client / R1500 / R800
FCE Medico Legal - Interview form and Assessment form / R1500 / R800
Medical Negligence Report Template / R6000 / R4000
Copy of Addendum / R1500 / R800
Copy of Joint Minute / R1500 / R800
VOC REHAB – Conditioning / Work Hardening protocol / R1500 / R800
To rent from our Test Library / Per patient / Per patient
RBANS TEST / R200 / R200
DTVP-A TEST / R200 / R200
BEARY TEST / R200 / R200
DTVP-2 / R200 / R200
MOCA / R200 / R200
Thurstone / R200 / R200
For all medical experts / specialists and Lawyers
(Attorneys specializing in 3rd party, MVA, medical negligence, and personal injury claims)
Tick / LAW MED – Medico Legal Software / Public rate / Membership rate
Installation & support fee (once off fee) / NA / R2999
& Monthly fee / N/A / R1799
(Invoice will be generated by LAW MED)
Tick / 2 Month Advertising Voucher / Public rate / Membership rate
(Be exposed monthly to +-6000 attorneys and corporate companies) / R8000 / R4000
Tick / Buy a Med Care Holdings Franchise / Public rate / Membership rate
R500 000 / R300 000
Circle your order / CPD Presentations to purchase / Public Rate / Membership Rate
Circle the presentations below which you are interested in ordering
Presentations for in-service training to purchase:
(This can be registered for CPD activities at your practice) / Public practitioner rate / MCH’s Membership rate:
(Discount applies)
Medico-legal field
RABS vs RAF / R3000 / R1000
Medical negligence case example and expert witness testimonies / R3000 / R1200
The expert witness / R2500 / R1000
Practice management / Business Management
How to run an ethical, successful , & profitable business / R3000 / R1200
Mindfulness and Leadership / R3000 / R1200
Strategy implementation for a growing company / R3000 / R1200
The value of using a model as a tool for occupation based practice / R3000 / R1200
Vocational Rehabilitation field
Quality of life and return to work / R2500 / R1000
Assistive devices / R1000 / R1000
Sustainable employment for people with physical disability / R1000 / R600
Occupational Health and Safety
Women performing risk work / R2500 / R1000
Occupational Health and Safety act / R2500 / R1000
Labor Law
Employment contract
Independent contractor contract / R2500
R2500 / R1000
R1000
Handling medical conditions in the work place
Handling epilepsy / R1000 / R600
Sensitization workshop – awareness of rheumatoid arthritis / R800 / R400
Coaching
The coaching process / R4000 / R3800
Equipment to purchase
Tick / ITEMS / PUBLIC RATE / MEMBERSHIP RATE
Equipment relating to occupational therapists
PCE Round Block Test / R2000 / R1500
PCE Peg Board Test / R2000 / R1500
Overhead manual Handling System with Adjustable Shelves / R6000 / R4000
Heart Rate Monitor / R1700 / R1200
Blood Pressure cuff / R1100 / R900
Plastic Crate / R400 / R200
Dumbbells:
(1kg; 1.5kg; 2.5kg; 3kg; 4kg; 5kg) / R200 per dumbbell / R180 per dumbbell
Weighted cuffs / R600 / R500
Airex balance pad / R1800 / R1200
Modapts Card Sorting / R700 / R500
Equipment relating to all medical experts
(Products from Bioptron and Moulmed)
Tick / ITEMS / Only one universal rate. Applies to members and the public
Products from Bioptron
BIOPTRON Pro 1 inc Floor Stand
Floor for Stand for BIOPTRON Pro
BIOPTRON 2 incl Floor Stand
Bioptron (Light treatment, for healing skin conditions, wounds & scars) / R 31 950 inc Vat
R 4 950 inc Vat
R 146 950 inc Vat
(Bioptron quotes will be provided)
Products from Moulmed
Tick / ITEMS / Only one universal rate. Applies to members and the public
Defibrillator / Prices upon request
Diathermy / Cautery / Electro-surgical devices / Prices upon request
Scales / Height measure / Prices upon request
ECG Units / Holter / Stress ECG systems / Prices upon request
Ultrasounds / Prices upon request
BLS / ALS / ILS BAGS / Prices upon request
Spirometer / Peak flow / Prices upon request
Patient monitoring devices / Prices upon request
UV steriliser and Suction Units / Prices upon request
General devices
(Such as alcohol swabs, exam lamps, ear syringes, scalpels, steal kidney dishes, Vaginal speculums, Snellen eye chart, Tongue depressors, pupil torch, oxygen concentrator, nail brushes, ECG paper, Laryngoscopes etc / Prices upon request
Littman Stethoscopes / Prices upon request
(Moulmed quotes will be provided)
Services to utilize pertaining to all medical experts / Specialists
Tick / SERVICES / PUBLIC RATE / MEMBERSHIP RATE
Need a Medico-legal OT Locum at your practice / R800p/hour / R500p/hour
Mentoring Packages:
5 sessions in FCE
5 sessions in Medico Legal / R1500p/hour
R1500p/hour / R1000p/hour
R1000p/hour
Typist
Assist in writing your medico-legal / FCE reports / R500p/hour / R250p/hour
Translator (Assistance per client) / R200 / R100
Legal assistance
(Assisting with the handling of Employee issues, assistance with business set-ups, structures & legal advice) / R2500 per consultation / R800 per consultation
Need practice management business assistance / R4000 per hourly session / R2000 per hourly session
Need Life coaching / R4500 per hourly session / R2500 per hourly session
Need Bridging Finance / A consultant will be in touch with you / A consultant will be in touch with you
Services to utilize pertaining to all Lawyers
Attorneys specializing in 3rd party, MVA, medical negligence, and personal injury claims
Tick / SERVICES / PUBLIC RATE / MEMBERSHIP RATE
Need a medico-legal expert of your choice / Dependant on quote per expert (will be mailed upon request) / Dependant on quote per expert (will be mailed upon request)
Discount included to member Attorneys
Need Bridging Finance / A consultant will be in touch with you / A consultant will be in touch with you
For Lawyers and Medical experts / Specialists
Tick / FACILITIES / PUBLIC RATE / MEMBERSHIP RATE
Renting a Consultation Room and Equipment (per month)
- Full day
- Half day
- Sessional / R10 000
R5000
R500
Accommodation @ our Boutique Guest House Manor / R1500 p/night / R900 p/night
Conferencing Facilities in Pretoria / R8000p/day / R5000p/day
For Occupational Therapists interested in Medico-legal work
Tick / TRAINING COURSES / PUBLIC RATE / MEMBERSHIP RATE
Medico Legal Foundation Course – 12 CPD points / R6000
Medico Legal Intermediate and advance Course – 30 CPD points / R9000
Medico Legal Practical’s – 12 CPD points / R6000
For any medical practitioner / specialist wanting to undergo medic-legal training
Tick / Mentoring sessions / PUBLIC RATE / MEMBERSHIP RATE
Mentoring session in your field of speciality in order to learn how to do medico-legal work / Amount Available upon request / Amount Available upon request
For any medical practitioner / specialist wanting to benefit from a nationwide support network and who wants discount on all products and services
(Members will enjoy all network benefits)
Tick / Expert Membership fees / Renewable every 12 months
MED CARE Expert / practitioner NETWORK MEMBERSHIP – per calendar year / Entry level package: R4500
Advanced package: R6000
For Attorneys (specializing in 3rd party, MVA, medical negligence, and personal injury claims)
wanting to benefit from a nationwide support network and who wants discount on all products and services
(Attorney Members will enjoy all network benefits)
Tick / Attorney Membership fees / Renewable every 12 months
Attorney NETWORK MEMBERSHIP – per calendar year / Attorney membership package: R12000
Banking details for MED CARE Holdings products and services
Account name: MED CARE HOLDINGS
Bank: ABSA
Branch code: 632005
Branch: Brooklyn
Account no: 4092328129
Reference to use: NAME + Invoiced number
Please take that different banking details will be provided for all products ordered from Bioptron, Moulmed, or LAW MED

For orders

Please tick off on the order form and mail it to

All queries can also be emailed to

Please send all proof of payments, irrespective of the product purchased to

(Use your name and product purchased as reference or your invoice number)

G. B. Cloete

Thank you for your business

Kind regards

Gwen-marieCloete : 0727206092 /

Director at MED CARE Holdings

Head Office: 705 Nieuwhoutstreet, on the corner of Nieuwhout and Windsor avenue, Garsfontein, Pretoria. Office number: 0129988243