Invoice Dentist in Kazakhstan Almaty –Free Word Template Download with AI
Address: 45 Abai Avenue, Almaty, 050000, Kazakhstan
Phone: +7 (727) 123-45-67
Email: [email protected]
BIN (BIN): 123456789012
Bank: Halyk Bank JSC
IBAN: KZ85125KZT500K12345678
Invoice Number: #INV-2023-8942
Date of Issue: October 24, 2023
Due Date: November 07, 2023
Service Location: Almaty, Kazakhstan
Bill ToPatient Name: Aigerim Serikbayeva
Address: 12 Dostyk Avenue, Apt 4B, Almaty, Kazakhstan
ID Number: 950101200001
Phone: +7 (777) 987-65-43
Insurance Provider: AlfaStrakhovanie (Policy #AS-998877)
Description of Dental Services RenderedThe following invoice details the professional dental care provided by our licensed specialists at our clinic in Almaty. All procedures were conducted in accordance with the Ministry of Health of the Republic of Kazakhstan standards. This document serves as the official financial record for the treatment plan executed during the patient's visit.
| # | Service Description | Date | Qty | Unit Price (KZT) | Total (KZT) |
|---|---|---|---|---|---|
| 1 |
Comprehensive Dental Examination & Consultation Initial assessment of oral health, periodontal screening, and treatment planning consultation with a senior dentist. |
Oct 20, 2023 | 1 | 15,000 | 15,000 |
| 2 |
Full Mouth Panoramic X-Ray (OPG) Digital radiographic imaging to assess bone structure and tooth alignment. |
Oct 20, 2023 | 1 | 8,500 | 8,500 |
| 3 |
Professional Teeth Cleaning (Ultrasonic Scaling) Removal of tartar and plaque buildup using ultrasonic technology, followed by polishing. |
Oct 21, 2023 | 1 | 25,000 | 25,000 |
| 4 |
Root Canal Therapy (Molar) Endodontic treatment for tooth #36. Includes anesthesia, access opening, cleaning, shaping, and obturation. |
Oct 22, 2023 | 1 | 65,000 | 65,000 |
| 5 |
Zirconia Dental Crown Fabrication and placement of a high-strength zirconia crown for tooth #36. Includes impression and temporary crown. |
Oct 24, 2023 | 1 | 120,000 | 120,000 |
| 6 |
Composite Filling (Anterior) Aesthetic tooth-colored filling for tooth #11 to restore structure and appearance. |
Oct 24, 2023 | 1 | 18,000 | 18,000 |
| 7 |
Prescription Medication Antibiotics and anti-inflammatory medication prescribed for post-procedure recovery. |
Oct 24, 2023 | 1 | 5,500 | 5,500 |
Currency: All amounts are listed in Kazakhstani Tenge (KZT).
Payment Methods: We accept cash, bank transfer, and major credit cards (Visa, MasterCard, UnionPay).
Due Date: Payment is due within 14 days of the invoice date. Late payments may incur a penalty fee of 0.1% per day.
Bank Transfer: Please include the Invoice Number (#INV-2023-8942) in the payment reference field to ensure proper allocation of funds.
This invoice confirms the completion of the dental procedures listed above at our Almaty facility. Please retain this document for your personal records and for any potential insurance reimbursement claims. If you have private health insurance, please submit this invoice along with the detailed medical report to your provider.
Follow-up Care: A follow-up appointment is recommended in 7 days to check the healing of the root canal and crown placement. Please contact our reception desk in Almaty to schedule this visit.
Legal Notice: This invoice is issued in accordance with the Tax Code of the Republic of Kazakhstan. Almaty Premium Dental Clinic guarantees the quality of materials and services provided. Any disputes regarding this invoice should be directed to our billing department within 30 days.
Authorized Signature
Dr. Kenzhebek Tulegenov
Chief Dentist
Patient Acknowledgement
Signature:
Date:
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