Invoice Dentist in Colombia Medellín –Free Word Template Download with AI
Specialized Dental Clinic
Carrera 43A # 8 - 12, Oficina 301
El Poblado, Medellín, Antioquia, Colombia
NIT: 900.123.456-7
Phone: +57 (4) 444 5555
Email: [email protected]
Invoice Number: FAC-2023-00892
Date of Issue: October 24, 2023
Due Date: November 07, 2023
Payment Status: Pending
Bill To:
Mr. Alejandro Gómez Restrepo
Calle 10 # 35 - 20, Apto 502
Laureles, Medellín, Antioquia, Colombia
ID (Cédula): 1.098.765.432
Email: [email protected]
Tax & Regulatory Info:
Tax Regime: Simple (Régimen Simple)
DIAN Code: 11001
Health EPS: Sanitas (Reference: 987654321)
Service Location: Medellín, Colombia
| # | Description of Dental Services | Code | Qty | Unit Price (COP) | Total (COP) |
|---|---|---|---|---|---|
| 1 |
Comprehensive Dental Examination & Consultation Includes panoramic X-ray analysis, periodontal assessment, and treatment plan formulation in accordance with Colombian dental standards. |
DX-001 | 1 | $150,000 | $150,000 |
| 2 |
Professional Dental Prophylaxis (Cleaning) Ultrasonic scaling, manual curettage, polishing, and fluoride application. Performed by certified dental hygienist in Medellín. |
PR-005 | 1 | $220,000 | $220,000 |
| 3 |
Composite Resin Restoration (Tooth #14) Direct aesthetic filling using high-quality composite material. Includes local anesthesia and post-operative instructions. |
RS-012 | 1 | $350,000 | $350,000 |
| 4 |
Root Canal Therapy (Tooth #19) Endodontic treatment including access, instrumentation, irrigation, and obturation. Follows international and local clinical protocols. |
RC-008 | 1 | $850,000 | $850,000 |
| 5 |
Ceramic Crown Fabrication & Placement Zirconia crown for tooth #19. Includes preparation, impression, temporary crown, and final cementation. |
CR-020 | 1 | $1,200,000 | $1,200,000 |
| 6 |
Follow-up Consultation Post-treatment evaluation to ensure proper healing and functionality of restorative work. |
FL-001 | 1 | $80,000 | $80,000 |
| Subtotal: | $2,850,000 |
| IVA (19% Tax): | $541,500 |
| Insurance Coverage (EPS): | -$1,000,000 |
| Total Due (COP): | $2,391,500 |
Payment Instructions:
Please make payment within 14 days of the invoice date. Payments can be made via bank transfer to Bancolombia, Account No. 123-456789-00, or in person at our clinic in El Poblado, Medellín. For international patients, we accept credit cards and wire transfers. Please include the invoice number as reference.
Bank Details:
Bank: Bancolombia
Account Name: SmileCare Medellín S.A.S.
Account Number: 123-456789-00
SWIFT Code: BCOCCOBB
Terms and Conditions:
1. This invoice is issued in accordance with the tax regulations of the DIAN (Dirección de Impuestos y Aduanas Nacionales) in Colombia.
2. All dental services are performed by licensed professionals registered with the Colombian Ministry of Health.
3. Prices are quoted in Colombian Pesos (COP) and include applicable taxes unless otherwise stated.
4. Late payments may incur a penalty of 2% per month on the outstanding balance.
5. This document serves as proof of payment for insurance claims and personal records.
6. Any disputes regarding this invoice should be resolved through the jurisdiction of Medellín, Antioquia, Colombia.
Authorized Electronic Signature
Dr. María Fernanda López
Lead Dentist - SmileCare Medellín
License No. 12345678
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