What is Annexe 12 used for in a nursing home (MR/MRS)?

It is the official AViQ document that justifies a month’s expenses: an individual expense note per resident and a summary note per insurance organisation.

Where do you generate Annexe 12 in Resthome?

Via the Print button: on a billing period for the summary note, on a per-resident billing record for the individual note.

What is the difference between an individual note and a summary note?

The individual note details the expenses of a single resident over three pages; the summary note lists all residents of the same insurance organisation with the totals.

Which amounts appear on Annexe 12?

The three mandatory amounts: payable by the insurance organisation (O.A.), payable by the patient and the total, together with the number of days of presence for the month.

Do you have to give Annexe 12 to the resident?

Yes: a copy of the individual expense note must be given to the beneficiary; the summary note accompanies the billing sent to the insurance organisation.

The Expense Note (Annexe 12)¶

Annexe 12 is the official document that justifies, month by month, the accommodation and care expenses of a nursing home (MR/MRS) resident. Resthome produces it in two complementary forms:

the Individual Expense Note — a detailed supporting document per resident;
the Summary Expense Note — a table per insurance organisation (O.A.) that groups all residents of the same insurance fund.

Both are generated from the Print button, from a billing period or a per-resident billing record.

An official AViQ document

Annexe 12 targets the “institutions referred to in Article 43/7, 4° of the Walloon Code of Social Action and Health”. Resthome automatically fills in the official form with your period’s data: you have nothing to copy out by hand.

Two documents, two scopes¶

Document	Scope	Printed template	Generated from
Individual Expense Note	One resident	`Annexe12_<resident>_<period>`	Billing per resident record → Print
Summary Expense Note	One insurance organisation	`NoteRecap_<period>`	Billing period → Print

The link between the two

Each line of the summary note carries an individual note number that refers back to the individual note of the corresponding resident. So you generally produce both documents for the same month: the summary for the O.A., the individual notes for the residents.

The Individual Expense Note (per resident)¶

This is the complete supporting document for a single resident for the month. Resthome generates it on the official form across three pages.

Page	Content
1. Resident summary	Identification of the institution (name, address, INAMI number) and of the insurance fund, period, the resident’s line (name, NISS registration number, days of presence) and the three mandatory amounts: payable by O.A., payable by patient, total.
2. Fixed costs	The care flat-rate (insurance-organisation share), with its AViQ pseudo-code, the daily price, the number of days and the amount — broken down by sub-period where applicable — as well as the incontinence rebate.
3. Supplements	The accommodation (the room), the supplements (television, telephone, laundry, pedicure, single room…), the (para)pharmaceutical medication and the supplements total.

The three mandatory amounts

The first page carries the three amounts required by electronic billing: payable by the O.A. (the reimbursed flat-rate, incontinence rebate included), payable by the patient (accommodation + supplements) and the total. These are the amounts that justify, to the resident, what the insurance fund covers and what remains for them to pay.

The flat-rate does not depend on the Katz category

The amount of the care flat-rate is the same for all Katz categories (AViQ tariffs): the category serves to declare the dependency profile to the insurance fund, not to set a different amount. See The INAMI flat-rate.

Generating an individual note¶

Open the month’s billing period (MR/MRS → Billing → Billing periods application).
Open the relevant resident’s billing record (“Billing per resident”).
Click Print → Annexe 12 — Individual Expense Note.
The PDF is generated in the name of the resident and the period.

Give a copy to the resident

The summary note certifies that “a copy of the individual expense note has been given to the beneficiary”. So remember to give the individual note (or a copy of it) to each resident or their representative.

The Summary Expense Note (per insurance organisation)¶

The summary note groups, for a month, all residents of the same insurance organisation in a single table. Resthome produces one page per O.A.: if your period includes residents affiliated with several insurance funds, the document contains as many pages as there are organisations.

Header of each page:

the institution identification: name, address, telephone, INAMI number;
the insurance-fund identification: number (O.A. code) and name;
the period covered (“Summary note from … to … — issued on …”).

The residents table has the following columns:

Column	Content
Individual note no.	Reference of the resident’s individual note
Beneficiary surname and first name	The resident
Registration number	The resident’s NISS
Number of days	Billed days of presence
Payable by O.A.	Share reimbursed by the insurance organisation
Payable by patient	Share payable by the resident
Total	Sum of the two

The last line totals the Grand total for the O.A., payable by patient and total. The document ends with a certification signed by the Institution Manager (date, name and signature).

Generating a summary note¶

Open the month’s billing period (or select it in the Billing periods list).
Click Print → Annexe 12 — Summary Note.
Resthome generates the PDF, one page per insurance organisation.

When to generate Annexe 12¶

Generate Annexe 12 once the month has been billed: the amounts pick up the billing lines calculated by Resthome (flat-rate, accommodation, supplements, medication, absences). If you change an invoice afterwards, refresh the period then regenerate the document so that it reflects the new amounts.

It accompanies the eFact

The summary note is the “paper” supporting document that accompanies the billing sent to each insurance organisation. For the complete electronic flow (sending the flat-rate to the insurance fund), see Billing a month, step by step.

Departure or death during the month

The amounts take into account the actual days of presence: a departure or death during the month is already reflected in the billing lines, and therefore in Annexe 12. See Departure and death.

Key points to remember¶

Annexe 12 exists in two forms: the individual note (per resident) and the summary note (per insurance organisation).
Both are generated from the Print button: the summary on the period, the individual one on the per-resident billing record.
The individual note carries the three mandatory amounts: payable by O.A., payable by patient and total.
The summary produces one page per insurance organisation and totals the Grand total for the O.A..
A copy of the individual note must be given to the resident.
The institution’s INAMI number and the tariffs are specific to your establishment: check that they are configured correctly.