Invoice Dentist in Sudan Khartoum –Free Word Template Download with AI

Bill To:

Patient Name: Ahmed Mohamed Hassan

Address: Al-Amir Street, Omdurman, Khartoum, Sudan

Phone: +249 912 345 678

Insurance Provider: Sudan National Health Insurance (If applicable)

Policy Number: SNHI-8842-XX

This document serves as an official Invoice for professional dental services rendered by Nile Valley Dental Clinic, a premier Dentist practice located in the heart of Sudan Khartoum. This invoice details the comprehensive oral health treatments provided to the patient listed above. As a leading healthcare provider in the region, we are committed to delivering high-quality dental care that meets international standards while serving the local community of Khartoum. The charges listed below reflect the current medical tariffs approved for dental practices operating within Sudan.

#	Description of Dental Services	Date of Service	Quantity	Unit Price (SDG)	Total (SDG)
1	Comprehensive Dental Examination & Consultation Initial assessment of oral health, review of medical history, and formulation of a treatment plan by the lead Dentist. Includes panoramic X-ray imaging.	Oct 10, 2023	1	500.00	500.00
2	Professional Dental Cleaning (Prophylaxis) Removal of plaque and tartar buildup using ultrasonic scalers and manual instruments. Polishing of teeth to prevent future decay. Essential maintenance for patients in Sudan Khartoum.	Oct 10, 2023	1	800.00	800.00
3	Composite Resin Fillings (Class II) Restoration of two posterior teeth affected by moderate cavities. Tooth-colored material used for aesthetic and functional repair.	Oct 12, 2023	2	1,200.00	2,400.00
4	Root Canal Therapy (Endodontics) Treatment of an infected pulp in the upper left molar. Includes removal of infected tissue, cleaning, shaping, and sealing of the root canals. Performed by a specialist Dentist.	Oct 15, 2023	1	3,500.00	3,500.00
5	Dental Crown (Porcelain-Fused-to-Metal) Fabrication and placement of a custom crown to restore the structural integrity and appearance of the tooth treated with root canal therapy.	Oct 20, 2023	1	4,000.00	4,000.00
6	Extraction of Impacted Wisdom Tooth Surgical removal of a lower right impacted wisdom tooth causing pain and potential infection risk. Includes local anesthesia and sutures.	Oct 22, 2023	1	2,500.00	2,500.00
7	Post-Operative Medication & Care Kit Prescription antibiotics, pain relievers, and antiseptic mouthwash provided to ensure proper healing following surgical procedures.	Oct 22, 2023	1	600.00	600.00

Subtotal: 14,300.00 SDG Discount (Loyalty Patient): -500.00 SDG VAT (15% - Sudan Tax Law): 2,040.00 SDG TOTAL DUE: 15,840.00 SDG

*Amount in words: Fifteen Thousand Eight Hundred Forty Sudanese Pounds Only.

Payment Terms and Conditions:

This Invoice is payable within 14 days of the date of issue. Payment can be made via bank transfer to Nile Valley Dental Clinic's account at Bank of Khartoum, or in cash at our clinic reception in Sudan Khartoum. Please reference the Invoice Number (INV-2023-10-045) when making a payment.

Late payments may incur a penalty fee of 2% per month. If you have any questions regarding the services provided by our Dentist team or the charges listed on this invoice, please contact our billing department immediately. We value your trust in our dental care services and strive to provide transparent billing practices.

Important Notice: This document is a valid financial record for tax purposes in Sudan. Please retain this invoice for your personal records and insurance claims. Our clinic adheres to all medical and financial regulations set forth by the Ministry of Health and the National Bank of Sudan.

Authorized Signature

Dr. Fatima Ali Ibrahim

Lead Dentist & Clinic Manager

Nile Valley Dental Clinic

Patient Acknowledgement

Signature:

Date:

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