Invoice Chemist in France Paris –Free Word Template Download with AI
Licensed Chemist & Pharmaceutical Dispensary
12 Rue de la Huchette, 75005 Paris, France
Téléphone: +33 (0)1 42 03 87 65 | Email: [email protected]
SIRET: 842 567 391 00021 | ADELI: 7505123456
Ordonnance Pharmaceutique – France Invoice / FactureInvoice Details
Invoice Number: FCT-2025-00487
Date of Issue: 14 June 2025
Due Date: 14 June 2025 (Immediate)
Payment Method: Carte Bancaire / Carte Vitale
Prescribing Physician: Dr. Émile Rousseau, 45 Rue des Écoles, 75005 Paris
Billed To (Patient)
Name: Madame Catherine Dubois
Address: 8 Avenue de l'Observatoire, 75006 Paris, France
Ameli Number: 1 85 06 75 123 456 78
Complementary Insurance: MGEN – Contract No. MG-2019-44521
Telephone: +33 (0)6 12 34 56 78
Dispensed Pharmaceutical Products & Services
| Ref. | Description of Product / Service | Quantity | Unit Price (€) | Amount (€) |
|---|---|---|---|---|
| 01 | Amoxicilline 1000 mg – 14 film-coated tablets (Antibiotic, prescription required) | 1 box | 4.87 | 4.87 |
| 02 | Paracétamol 500 mg – 16 tablets (Analgesic, over-the-counter) | 2 boxes | 2.15 | 4.30 |
| 03 | Insuline Glargine 100 UI/ml – 3 ml pre-filled pen (Diabetes management, prescription required) | 5 pens | 18.42 | 92.10 |
| 04 | Metformine 850 mg – 60 film-coated tablets (Antidiabetic, prescription required) | 2 boxes | 5.63 | 11.26 |
| 05 | Crème Hydratante Dermatologique 50 ml (Dermatological moisturiser, over-the-counter) | 1 tube | 12.90 | 12.90 |
| 06 | Pharmaceutical Consultation & Medication Review by Licensed Chemist | 1 session | 0.00 | 0.00 |
| 07 | Glucose Test Strips – 50 units (Diagnostic consumable, prescription required) | 1 pack | 14.75 | 14.75 |
| 08 | Insulin Pen Needles 32G – 100 units (Medical consumable, prescription required) | 1 box | 8.30 | 8.30 |
| Subtotal (HT) | 148.48 € |
|---|---|
| TVA 2.10% (Pharmaceutical products) | 3.12 € |
| TVA 5.50% (Dermatological products) | 0.71 € |
| TVA 20% (Consultation & services) | 0.00 € |
| Total TTC (Grand Total) | 152.31 € |
| Amount Reimbursed by Assurance Maladie (Ameli) | 108.22 € |
| Amount Reimbursed by MGEN (Complementary Insurance) | 32.15 € |
| Patient Out-of-Pocket (Reste à Charge) | 11.94 € |
Important Notes & Legal Information
- This invoice has been issued by Pharmacie du Quartier Latin, a licensed chemist (pharmacie d'officine) registered with the Ordre des Pharmaciens de Paris, in full compliance with the French Public Health Code (Code de la Santé Publique), Articles L.4211-1 through L.4211-13.
- All prescription medications listed above were dispensed in accordance with a valid medical prescription (ordonnance) issued by Dr. Émile Rousseau, a registered physician practising in the 5th arrondissement of Paris, France. The original prescription has been retained by this chemist in accordance with French regulatory requirements for a minimum period of five years.
- The patient's Carte Vitale (Ameli health insurance card) was scanned and processed at the point of sale. The reimbursement amounts indicated above are provisional and subject to final validation by the Caisse Primaire d'Assurance Maladie (CPAM) of Paris and the complementary insurer MGEN. The patient may be required to settle any residual difference within thirty (30) days of the final reimbursement statement.
- Pharmaceutical products dispensed by this chemist in Paris, France, are subject to the French Value Added Tax (TVA) at the reduced rate of 2.10% for essential medicines and 5.50% for certain dermatological and hygiene products, as stipulated by the French General Tax Code (Code Général des Impôts), Article 279-0° bis.
- This invoice constitutes the official fiscal document (facture) for the transaction. In the event of a return or exchange of unopened pharmaceutical products, the patient must present this invoice along with the original packaging to the counter of this chemist within a period of fourteen (14) calendar days from the date of purchase, in accordance with the consumer protection provisions of the French Consumer Code (Code de la Consommation).
- The patient is advised to store all dispensed medications in accordance with the instructions provided by the dispensing chemist. Insulin products must be kept refrigerated between 2°C and 8°C. In case of adverse drug reactions, the patient should contact this pharmacy or the Agence Nationale de Sécurité du Médicament et des Produits de Santé (ANSM) immediately.
- This document is issued in the French Republic. For any dispute regarding this invoice, the competent jurisdiction shall be the Tribunal Judiciaire de Paris, 5th arrondissement. The patient retains the right to file a complaint with the Ordre des Pharmaciens de Paris or the Direction Régionale de l'Alimentation, de l'Agriculture et de la Forêt (DRAAF) Île-de-France.
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