Invoice Dentist in Malaysia Kuala Lumpur –Free Word Template Download with AI
Lot 12, Level 3, Menara KL Dental Centre
Jalan Tun Razak, 50400 Kuala Lumpur, Malaysia
Tel: +603-2188 9900 | Email: [email protected]
Company Reg: 201501023456 (1234567-X)
SSM Registered Dental Practice
Invoice No: KLDC-2024-0892
Date: 15 October 2024
Due Date: 15 November 2024
Payment Status: Pending
Billed To:
Patient Name: Mr. Ahmad Razak bin Ismail
IC Number: 850612-10-5678
Address: No. 45, Jalan Bukit Bintang, 55100 Kuala Lumpur, Malaysia
Contact: +6012-345 6789
Email: [email protected]
Insurance: Great Eastern Takaful (Policy: GE-9876543)
Professional Dental Services Rendered
This invoice represents the comprehensive dental care provided at our Kuala Lumpur facility in accordance with the Malaysian Dental Council guidelines and standard clinical practices. All procedures were performed by licensed dental professionals registered with the Dental Council of Malaysia.
| Item No. | Description of Dental Service | Procedure Code | Date of Service | Quantity | Unit Price (MYR) | Total (MYR) |
|---|---|---|---|---|---|---|
| 1 | Comprehensive Dental Examination and Consultation including oral cancer screening and periodontal assessment | DEX-001 | 10 Oct 2024 | 1 | 150.00 | 150.00 |
| 2 | Full Mouth Digital X-Ray (OPG) and Bitewing Radiographs for diagnostic purposes | RAD-002 | 10 Oct 2024 | 1 | 200.00 | 200.00 |
| 3 | Professional Dental Scaling and Polishing (Upper and Lower Arch) using ultrasonic technology | HYG-003 | 10 Oct 2024 | 1 | 350.00 | 350.00 |
| 4 | Composite Resin Filling - Tooth #16 (Upper Right First Molar) - Class II Restoration | REST-004 | 12 Oct 2024 | 1 | 450.00 | 450.00 |
| 5 | Root Canal Treatment - Tooth #36 (Lower Left First Molar) - Multi-Canal Endodontic Therapy | ENDO-005 | 12 Oct 2024 | 1 | 1,800.00 | 1,800.00 |
| 6 | Porcelain Crown Preparation and Temporary Crown Placement - Tooth #36 | PROST-006 | 12 Oct 2024 | 1 | 600.00 | 600.00 |
| 7 | Local Anesthesia (Lidocaine with Epinephrine) - Multiple Injections | ANES-007 | 12 Oct 2024 | 3 | 30.00 | 90.00 |
| 8 | Prescription Medication: Amoxicillin 500mg (14 tablets) and Ibuprofen 400mg (10 tablets) | PHARM-008 | 12 Oct 2024 | 1 | 45.00 | 45.00 |
| 9 | Follow-up Consultation and Post-Treatment Assessment | FOLLOW-009 | 15 Oct 2024 | 1 | 80.00 | 80.00 |
Payment Information
Bank: Maybank Berhad
Account Name: KL Premier Dental Clinic Sdn Bhd
Account Number: 5678 9012 3456
Reference: Please use Invoice No. KLDC-2024-0892 as payment reference
Accepted Payment Methods: Bank Transfer, Credit/Debit Card (Visa, Mastercard), Touch 'n Go eWallet, GrabPay
Payment Deadline: 15 November 2024. Late payments may incur a 2% monthly interest charge.
Important Notes and Terms
1. This invoice is issued in accordance with the Malaysian Dental Council regulations and the Private Healthcare Facilities and Services Act 1998 (Act 586).
2. All dental procedures were performed by qualified dentists registered with the Dental Council of Malaysia and practicing at our Kuala Lumpur clinic.
3. Insurance claims have been processed directly with Great Eastern Takaful. Please verify coverage details with your insurance provider.
4. The porcelain crown for tooth #36 will be fabricated and ready for cementation in 2-3 weeks. A separate appointment will be scheduled.
5. Please maintain good oral hygiene and attend your next dental check-up in 6 months as recommended by your dentist.
6. For any queries regarding this invoice, please contact our billing department at +603-2188 9900 or email [email protected].
7. This document serves as an official receipt upon payment confirmation and can be used for tax deduction purposes under Malaysian tax regulations.
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