Invoice Doctor General Practitioner in Brazil Rio de Janeiro –Free Word Template Download with AI
CRM-RJ: 78.901 | RQE: 12.345
Av. Atlântica, 1702, Copacabana
Rio de Janeiro, RJ - 22021-001
Brazil
Email: [email protected]
Phone: +55 (21) 3234-5678
Invoice Number: INV-2023-10-045
Date of Issue: October 25, 2023
Due Date: November 05, 2023
Billed To (Patient)
Name: Maria Fernanda Oliveira
CPF: 123.456.789-00
Address: Rua das Laranjeiras, 450, Apto 302
Laranjeiras, Rio de Janeiro, RJ - 22240-000
Brazil
Phone: +55 (21) 99876-5432
Service Provider
Entity: Clínica Médica Silva & Associados
CNPJ: 12.345.678/0001-90
Location: Rio de Janeiro, RJ
Bank Details:
Banco do Brasil
Agency: 1234-5
Account: 98765-4
PIX Key: [email protected]
Professional Services Rendered
The following invoice details the medical services provided by the Doctor General Practitioner in accordance with the standards set by the Federal Council of Medicine (CFM) and the Regional Council of Medicine of Rio de Janeiro (CRM-RJ). These services were rendered at the clinic located in Rio de Janeiro, Brazil.
| Description of Service | Procedure Code (CBHPM) | Date | Unit Price (BRL) | Total (BRL) |
|---|---|---|---|---|
|
General Medical Consultation Comprehensive evaluation of patient health status, including history taking, physical examination, and initial diagnosis. This service covers the standard consultation fee for a Doctor General Practitioner in Rio de Janeiro. |
02.01.01.001-0 | Oct 20, 2023 | R$ 350,00 | R$ 350,00 |
|
Follow-up Consultation Review of previous test results and adjustment of treatment plan. Includes monitoring of chronic conditions and prescription management. |
02.01.01.002-8 | Oct 22, 2023 | R$ 280,00 | R$ 280,00 |
|
Medical Certificate Issuance Preparation and issuance of official medical certificates for employment or academic purposes, valid within the jurisdiction of Rio de Janeiro, Brazil. |
02.01.02.005-2 | Oct 23, 2023 | R$ 150,00 | R$ 150,00 |
|
Home Visit Consultation Specialized house call service provided by the Doctor General Practitioner to the patient's residence in the Laranjeiras district of Rio de Janeiro. Includes travel time and on-site examination. |
02.01.01.010-9 | Oct 24, 2023 | R$ 600,00 | R$ 600,00 |
Payment Terms and Legal Notes:
- Currency: All amounts are quoted in Brazilian Reais (BRL).
- Payment Method: Payment can be made via PIX (instant transfer), bank slip (boleto bancário), or credit card. Please reference Invoice Number INV-2023-10-045.
- Late Fees: In accordance with Brazilian commercial law, a late payment interest of 1% per month and a fine of 2% will be applied to overdue invoices.
- Tax Compliance: This invoice complies with the tax regulations of the City of Rio de Janeiro. The ISS (Service Tax) has been calculated and will be remitted to the municipal treasury.
- Medical Records: This document serves as a financial record. For medical records, please request the official "Prontuário Médico" separately, adhering to the LGPD (General Data Protection Law) of Brazil.
- Validity: This invoice is valid for 30 days from the date of issue.
Authorized Signature
Dr. Carlos Eduardo Silva
Doctor General Practitioner
Patient Acknowledgement
Maria Fernanda Oliveira
Date: _______________
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