Invoice Dentist in Nepal Kathmandu –Free Word Template Download with AI
Location: Thamel, Kathmandu, Nepal
Address: Thamel Marg, Near Hotel Yak & Yeti, Kathmandu 44600
Phone: +977-1-4701234
Email: [email protected]
PAN/VAT No: 123456789
License No: MoHP/Dental/2078/001
Invoice #: INV-2023-0892
Date: 2023-10-25
Due Date: 2023-11-25
Status: Pending
Bill To (Patient)Name: Rajesh Sharma
Address: Baneshwor, Kathmandu, Nepal
Phone: +977-9801234567
Email: [email protected]
Patient ID: PAT-998877
Treatment DetailsTreating Dentist: Dr. Anita Gurung, BDS, MDS
Appointment Date: 2023-10-25
Procedure Type: Restorative & Cosmetic
Insurance: Self-Pay
Description of Services Rendered| # | Service / Procedure Description | Code | Qty | Unit Price (NPR) | Total (NPR) |
|---|---|---|---|---|---|
| 1 | Comprehensive Dental Examination and Consultation in Kathmandu | D0150 | 1 | 2,500.00 | 2,500.00 |
| 2 | Full Mouth Digital X-Rays (OPG & Bitewing) | D0330 | 1 | 3,000.00 | 3,000.00 |
| 3 | Professional Dental Cleaning (Scaling & Polishing) | D1110 | 1 | 4,500.00 | 4,500.00 |
| 4 | Root Canal Treatment (Molar Tooth #30) | D3330 | 1 | 15,000.00 | 15,000.00 |
| 5 | Composite Resin Filling (Tooth #30) | D2391 | 1 | 5,000.00 | 5,000.00 |
| 6 | Porcelain Crown Preparation and Temporary Crown | D2740 | 1 | 12,000.00 | 12,000.00 |
| 7 | Local Anesthesia (Lidocaine with Epinephrine) | D9920 | 2 | 500.00 | 1,000.00 |
| 8 | Prescription Medication (Antibiotics & Painkillers) | D9940 | 1 | 1,500.00 | 1,500.00 |
Amount Paid: NPR 20,000.00 (Cash)
Balance Due: NPR 27,765.25
Payment Method Accepted: Cash, eSewa, Khalti, Bank Transfer (Nabil Bank)
Bank Details: Nabil Bank Ltd., Thamel Branch, A/C No: 0123456789
Terms and Conditions1. This invoice is issued by Himalayan Smile Dental Clinic, a registered dental practice in Kathmandu, Nepal. All services are performed by licensed dentists adhering to the standards of the Nepal Dental Association.
2. Payment is due within 30 days of the invoice date. Late payments may incur a penalty of 2% per month.
3. VAT is calculated as per the Inland Revenue Department of Nepal regulations.
4. Please retain this invoice for your records and for any insurance claims. A duplicate copy can be requested via email.
5. For any discrepancies in billing, please contact our office within 7 days of receiving this invoice.
6. Future appointments for crown placement should be scheduled within 2 weeks. Failure to do so may result in additional charges.
Clinic Stamp Authorized SignatureHimalayan Smile Dental Clinic Patient Signature
Acknowledging Receipt of Invoice ⬇️ Download as DOCX Edit online as DOCX
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