Invoice Doctor General Practitioner in DR Congo Kinshasa –Free Word Template Download with AI

INVOICE

Invoice Number: INV-2023-KIN-0892

Date of Issue: October 24, 2023

Due Date: November 07, 2023

Payment Terms: Net 14 Days

Bill To (Patient / Insurance Entity)

Name: Jean-Pierre Mukendi

Address: Quartier Limete, Avenue de la Liberté

City: Kinshasa, DR Congo

Patient ID: PAT-882910

Insurance Provider: Assurance Santé Congo (Ref: ASC-9921)

Service Provider (Doctor General Practitioner)

Doctor Name: Dr. Sarah Mbemba, MD

Specialty: Doctor General Practitioner

Licence No: ORDMEC-KIN-4452

Facility: Clinique Médicale du Fleuve

Location: Kinshasa, DR Congo

#	Description of Medical Services	Date of Service	Quantity	Amount (CDF)
1	Initial Consultation - Doctor General Practitioner Comprehensive physical examination and medical history review conducted by a licensed Doctor General Practitioner in Kinshasa. Includes assessment of vital signs, respiratory function, and cardiovascular health.	Oct 20, 2023	1	150,000 CDF
2	Diagnostic Laboratory Referral & Analysis Coordination of blood work (CBC, Malaria Rapid Test, Typhoid Serology) required for accurate diagnosis within the DR Congo Kinshasa healthcare context. Includes interpretation of results by the Doctor General Practitioner.	Oct 20, 2023	1	85,000 CDF
3	Prescription Management & Pharmacological Counseling Detailed prescription of antibiotics and antipyretics tailored to the patient's condition. Includes counseling on dosage and potential side effects, adhering to DR Congo national health guidelines.	Oct 20, 2023	1	45,000 CDF
4	Follow-up Consultation - Doctor General Practitioner Review of treatment efficacy and patient recovery status. Adjustments to the care plan made by the Doctor General Practitioner to ensure optimal health outcomes in Kinshasa.	Oct 24, 2023	1	100,000 CDF
5	Medical Certificate Issuance Official documentation of medical leave and fitness status, stamped and signed by the Doctor General Practitioner, valid for employers and institutions in DR Congo Kinshasa.	Oct 24, 2023	1	30,000 CDF

Subtotal: 410,000 CDF Discount (Insurance Coverage): -100,000 CDF Tax (TVA - 16%): 57,600 CDF Total Due: 367,600 CDF

Payment Instructions & Banking Details

Please remit payment in Congolese Francs (CDF) to the following bank account located in Kinshasa, DR Congo:

Bank Name: Ecobank DR Congo
Branch: Gombe, Kinshasa
Account Name: Clinique Médicale du Fleuve
Account Number: 001234567890
SWIFT Code: ECOBCD22

Alternatively, payments can be made via mobile money (M-Pesa or Airtel Money) to the number +243 81 000 0000. Please reference the Invoice Number (INV-2023-KIN-0892) in all transactions.

Terms and Conditions

1. This Invoice represents the fees for medical services rendered by a Doctor General Practitioner at Clinique Médicale du Fleuve in Kinshasa, DR Congo.
2. Payment is due within 14 days of the invoice date. Late payments may incur a penalty fee of 2% per month.
3. All medical diagnoses and treatments are based on the professional judgment of the Doctor General Practitioner.
4. In the event of a dispute regarding the charges, please contact the clinic administration within 7 days of receiving this Invoice.
5. This document serves as an official receipt for tax purposes in DR Congo Kinshasa.
6. Patient confidentiality is strictly maintained in accordance with the medical ethics code of the Democratic Republic of Congo.

Authorized By:

Dr. Sarah Mbemba
Doctor General Practitioner
Clinique Médicale du Fleuve

Patient Acknowledgement:

Patient Signature
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX

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