Invoice Dentist in DR Congo Kinshasa –Free Word Template Download with AI
Specialized Dental Care in Kinshasa
Address: Avenue de la Paix, Gombe, Kinshasa, Democratic Republic of the Congo
Phone: +243 81 234 5678 | Email: [email protected]
Registration Number: RC/KIN/2020/001234
Tax Identification Number (NIF): 0012345678901
Invoice Number: INV-2024-0892
Date of Issue: October 15, 2024
Due Date: October 30, 2024
Payment Terms: Net 15 Days
Bill To:Patient Name: Jean-Pierre Mukendi
Address: Quartier Lumumba, Avenue Kasa-Vubu, Kinshasa, DR Congo
Phone: +243 99 876 5432
Email: [email protected]
Patient ID: PAT-2024-456
Description of Dental Services RenderedThe following invoice details the comprehensive dental care services provided by our licensed dentist at Clinique Dentaire Moderne du Congo, located in the heart of Kinshasa, Democratic Republic of the Congo. All procedures were performed in accordance with international dental standards and local regulations governing healthcare services in DR Congo. This document serves as an official record of treatment for both the patient and the clinic, ensuring transparency in billing and facilitating any necessary insurance claims or medical records updates.
| Item # | Description of Service | Date of Service | Quantity | Unit Price (CDF) | Total (CDF) |
|---|---|---|---|---|---|
| 1 | Comprehensive Dental Examination and Consultation | October 10, 2024 | 1 | 50,000 | 50,000 |
| 2 | Full Mouth Panoramic X-Ray Imaging | October 10, 2024 | 1 | 75,000 | 75,000 |
| 3 | Professional Dental Cleaning (Prophylaxis) | October 12, 2024 | 1 | 80,000 | 80,000 |
| 4 | Composite Filling - Upper Right Molar (Tooth #3) | October 12, 2024 | 1 | 120,000 | 120,000 |
| 5 | Root Canal Treatment - Lower Left Premolar (Tooth #20) | October 14, 2024 | 1 | 350,000 | 350,000 |
| 6 | Dental Crown Preparation and Temporary Crown Placement | October 14, 2024 | 1 | 200,000 | 200,000 |
| 7 | Prescription Medication (Antibiotics and Pain Relief) | October 14, 2024 | 1 | 45,000 | 45,000 |
| 8 | Follow-up Consultation and Treatment Assessment | October 15, 2024 | 1 | 30,000 | 30,000 |
Important Notes and Payment Information:
Currency: All amounts are quoted in Congolese Francs (CDF), the official currency of the Democratic Republic of the Congo. Exchange rates may apply for international payments.
Payment Methods: Payments can be made via bank transfer to our account at Banque Commerciale du Congo (BCC), cash payment at our Kinshasa clinic, or mobile money through Airtel Money or M-Pesa. Please reference the invoice number when making payments.
Bank Details: Bank: Banque Commerciale du Congo (BCC), Account Name: Clinique Dentaire Moderne du Congo SARL, Account Number: 1234567890, SWIFT Code: BCCDCDKI.
Next Appointment: Your dentist has scheduled your crown placement appointment for November 5, 2024, at 10:00 AM. Please arrive 15 minutes early. A separate invoice will be issued for this procedure.
Medical Records: This invoice is part of your permanent dental record maintained at our clinic in Kinshasa. You are entitled to request a copy of your complete dental history at any time.
Warranty: All dental work performed by our licensed dentist comes with a 12-month warranty against defects in materials and workmanship, in accordance with healthcare regulations in DR Congo.
Contact: For any questions regarding this invoice or your dental treatment, please contact our office at +243 81 234 5678 or visit us at our clinic in Gombe, Kinshasa. We are committed to providing exceptional dental care to our patients in the Democratic Republic of the Congo.
Authorized by:
Dr. Marie-Claire Kabongo
Lead Dentist
Clinique Dentaire Moderne du Congo
Kinshasa, DR Congo
Patient Acknowledgment:
Signature: ___________________
Date: ___________________
I acknowledge receipt of this invoice and the services rendered.
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