Invoice Doctor General Practitioner in Canada Toronto –Free Word Template Download with AI
General Practitioner & Family Physician
123 Medical Arts Boulevard, Suite 400
Toronto, Ontario, Canada M5H 2N2
Phone: (416) 555-0199 | Fax: (416) 555-0198
Email: [email protected]
COL Number: 12345678 | SIN: ***-***-789
Invoice Number: INV-2023-10-045
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Service Period: October 1, 2023 - October 24, 2023
Bill To / Patient InformationName: Johnathan A. Smith
Address: 456 King Street West, Apt 12B
City/Province/Postal: Toronto, ON, M5V 1K1
Date of Birth: 1985-04-12
OHIP Number: A123456789
Private Insurance: Sun Life Financial (Group #998877)
Services RenderedThe following invoice details the medical services provided by Dr. Sarah Jenkins, a licensed General Practitioner in Toronto, Canada. Please note that services covered by the Ontario Health Insurance Plan (OHIP) are billed directly to the Ministry of Health and appear here for record-keeping purposes only. Items marked as "Non-Insured" require payment from the patient or their supplementary private insurance provider.
| Date | Description of Service | Fee Schedule Code | Insurer | Amount (CAD) |
|---|---|---|---|---|
| Oct 02, 2023 | Office Visit - Comprehensive Assessment (15 mins) | K010 | OHIP | $0.00 |
| Oct 05, 2023 | Home Visit - Urgent Medical Attention | K020 | OHIP | $0.00 |
| Oct 10, 2023 | Medical Certificate for Employment (Non-Insured) | N/A | Patient | $75.00 |
| Oct 12, 2023 | Travel Health Consultation & Vaccination Advice | N/A | Patient | $120.00 |
| Oct 15, 2023 | Office Visit - Follow-up Consultation | K010 | OHIP | $0.00 |
| Oct 18, 2023 | Disability Certificate (Form 1) - Non-Insured | N/A | Patient | $100.00 |
| Oct 20, 2023 | Prescription Renewal & Medication Review | K010 | OHIP | $0.00 |
| Oct 22, 2023 | Letter to Insurance Company (Detailed History) | N/A | Patient | $150.00 |
Payment is due within 30 days of the invoice date. Please make all cheques payable to Dr. Sarah Jenkins. For electronic transfers, please use the details below. When making a payment, please include the Invoice Number (INV-2023-10-045) in the reference field.
Bank: Royal Bank of Canada
Transit: 00123
Institution: 003
Account: 12345678
Mail Payments To:
Dr. Sarah Jenkins
123 Medical Arts Boulevard, Suite 400
Toronto, ON M5H 2N2
Terms and Conditions1. OHIP Coverage: As per the Ontario Health Insurance Plan, medically necessary services provided by a General Practitioner are covered. However, administrative services, medical certificates for non-medical purposes, travel health forms, and disability forms for private insurance are not covered and are the responsibility of the patient.
2. Taxation: While most medical services in Canada are exempt from GST/HST, administrative fees and non-medical certificates are considered taxable services under Canadian tax law. The 13% Harmonized Sales Tax (HST) applicable in Toronto, Ontario, has been applied to the non-insured items listed above.
3. Privacy: Your personal health information is protected under the Personal Health Information Protection Act (PHIPA) of Ontario. This invoice contains limited information necessary for billing purposes.
4. Disputes: If you have any questions regarding this invoice or believe there is an error, please contact our billing department at (416) 555-0199 within 14 days of receipt.
Thank you for choosing our practice for your healthcare needs in Toronto. We are committed to providing high-quality, compassionate care.
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