Invoice Chemist in Iran Tehran –Free Word Template Download with AI
License No: IR-TEH-2019-48732
Address: No. 42, Vali-e-Asr Street, Enghelab Square, Tehran, Iran
Phone: +98-21-8876-5432 | Fax: +98-21-8876-5433
Email: [email protected]
Operating Hours: 08:00 – 22:00 (Saturday – Thursday)
Licensed Chemist – Tehran MunicipalityBilled To (Customer)
Name: Mr. Reza Mohammadi
Customer ID: CUST-TEH-11204
Address: Apartment 7, Building 3, Shariati Avenue, District 6, Tehran, Iran
Phone: +98-912-345-6789
National ID (Shenase Melli): 004-872-1935
Prescribing Physician
Doctor: Dr. Saeed Karimi, MD (Internal Medicine)
Clinic: Tehran Medical Center, District 1
Prescription No: RX-2025-TEH-9921
Prescription Date: 14 June 2025
Insurance Provider: Tamin-e Ejtemaei (Social Security Organization)
| # | Item Description | Product Code | Quantity | Unit Price (IRR) | Subtotal (IRR) | Insurance |
|---|---|---|---|---|---|---|
| 1 | Amoxicillin 500mg Capsules (21 caps) – Antibiotic, prescribed by Dr. Karimi | PH-AMX-500-21 | 2 boxes | 185,000 | 370,000 | 70% covered |
| 2 | Omeprazole 20mg Tablets (28 tabs) – Gastroprotective agent | PH-OMP-20-28 | 1 box | 245,000 | 245,000 | 70% covered |
| 3 | Metformin 850mg Tablets (60 tabs) – Antidiabetic medication | PH-MET-850-60 | 2 boxes | 310,000 | 620,000 | 80% covered |
| 4 | Ibuprofen 400mg Tablets (30 tabs) – Analgesic / Anti-inflammatory | PH-IBU-400-30 | 1 box | 98,000 | 98,000 | Self-pay |
| 5 | Vitamin D3 50,000 IU Softgels (4 caps) – Supplement | PH-VIT-D3-50K | 1 box | 155,000 | 155,000 | Self-pay |
| 6 | Saline Nasal Spray 30ml – OTC, recommended by chemist | PH-SAL-30ML | 2 units | 72,000 | 144,000 | Self-pay |
| 7 | Pharmacy Dispensing & Consultation Fee (Chemist Service) | SVC-DISP-001 | 1 service | 50,000 | 50,000 | Self-pay |
Subtotal (All Items):1,682,000 IRR
Insurance Coverage (Tamin-e Ejtemaei):− 924,000 IRR
Customer Co-payment:758,000 IRR
VAT (9% – Iranian Value Added Tax):68,220 IRR
GRAND TOTAL DUE:826,220 IRR
≈ 826,220 Iranian Rials
Notes & Chemist Recommendations
- Amoxicillin must be taken with food. Complete the full 7-day course even if symptoms improve. Do not skip doses.
- Omeprazole should be taken 30 minutes before breakfast on an empty stomach for optimal absorption.
- Metformin 850mg: take one tablet twice daily with meals to minimize gastrointestinal discomfort.
- Vitamin D3 50,000 IU: take one softgel once weekly with a fatty meal for better absorption. Do not exceed the prescribed frequency.
- All medications should be stored below 25°C, away from direct sunlight and moisture. Keep out of reach of children.
- If you experience any allergic reaction (rash, swelling, difficulty breathing), discontinue use immediately and contact your physician or visit the nearest emergency department in Tehran.
- This invoice is valid for insurance reimbursement claims submitted within 30 days of the date of issue.
Terms & Conditions – Dr. Farhad Chemist & Pharmacy, Tehran, Iran
- This invoice constitutes a formal record of pharmaceutical products and services dispensed by Dr. Farhad Chemist & Pharmacy, a licensed chemist operating under the supervision of the Tehran Municipality Health Department and the Iranian Food and Drug Administration (IFDA).
- All prescription medications listed in this invoice were dispensed in accordance with a valid prescription issued by a licensed physician registered in the Iranian medical system. The chemist has verified the prescription authenticity prior to dispensing.
- Payment is due within 15 calendar days from the date of issue. Late payments may incur a 2% monthly surcharge as per Iranian commercial regulations.
- Insurance claims must be submitted directly to the Tamin-e Ejtemaei (Social Security Organization) or the relevant private insurance provider. This chemist in Tehran, Iran, will provide any additional documentation required for the claims process upon request.
- Unused or partially used medications may be returned within 7 days of purchase, provided the original packaging is intact and the product has not been compromised. A refund will be processed to the original payment method.
- All prices are quoted in Iranian Rials (IRR) and are subject to change based on the Iranian Food and Drug Administration's approved pricing schedule. The 9% VAT is applied in compliance with the Islamic Republic of Iran's tax regulations.
- This invoice is issued in the English language for the convenience of the customer. The official Persian (Farsi) copy is retained at the pharmacy and is available upon request. In case of any discrepancy, the Persian-language document shall prevail under Iranian law.
- Dr. Farhad Chemist & Pharmacy is committed to providing the highest standard of pharmaceutical care in Tehran, Iran. For any questions regarding this invoice, medication usage, or insurance matters, please contact our chemist team during operating hours.
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