Invoice Doctor General Practitioner in Egypt Alexandria –Free Word Template Download with AI

Bill To (Patient):

Name: Mr. Mohamed Ali Ibrahim
Address: 45 Saad Zaghloul Street, Raml Station
Alexandria, Egypt
Phone: +20 10 1234 5678
National ID: 29001012345678

Insurance / Payment Info:

Insurance Provider: Bupa Egypt
Policy Number: BUP-EG-998877
Group ID: CORP-554
Payment Method: Cash / Credit Card

Services Rendered by Doctor General Practitioner

#	Description of Medical Service	Date	Quantity	Amount (EGP)
1	Initial Consultation - General Practitioner Comprehensive physical examination and medical history review conducted by Dr. Ahmed Hassan. Includes assessment of vital signs, respiratory system check, and cardiovascular evaluation.	Oct 24, 2023	1	500.00
2	Diagnostic Blood Work Order & Interpretation Ordering and subsequent analysis of Complete Blood Count (CBC), Fasting Blood Sugar, and Lipid Profile. Includes detailed explanation of results to the patient.	Oct 24, 2023	1	350.00
3	Prescription Management Issuance of pharmaceutical prescriptions for antibiotic therapy and pain management. Includes dosage instructions and follow-up advice.	Oct 24, 2023	1	100.00
4	Medical Certificate Issuance Official medical certificate for work absence due to acute illness, stamped and signed by the licensed General Practitioner in Alexandria.	Oct 24, 2023	1	150.00
5	Referral to Specialist Formal referral letter to a Cardiologist at Alexandria University Hospital for further evaluation based on initial findings.	Oct 24, 2023	1	100.00

Subtotal: 1,200.00 EGP Value Added Tax (VAT) 14%: 168.00 EGP Insurance Coverage: -800.00 EGP Total Due (Patient Responsibility): 568.00 EGP Payment Instructions

Please make payment in Egyptian Pounds (EGP). Payments can be made via cash at the clinic reception in Alexandria, or via bank transfer to the following account:

Bank Name: National Bank of Egypt (NBE)
Branch: Smouha Branch
Account Name: Alexandria Coastal Medical Center
Account Number: 1001234567890
IBAN: EG38 0019 0001 0000 0100 1234 56789

Terms and Conditions

This invoice is issued in accordance with the Egyptian Medical Syndicate regulations and local tax laws.
Payment is due upon receipt of this invoice unless otherwise arranged with the clinic administration.
For insurance claims, please submit this original invoice along with the medical report to your insurance provider.
Any disputes regarding charges must be raised within 7 days of the date of service.
This document serves as an official receipt for tax and insurance purposes in Egypt.
The services provided by the Doctor General Practitioner are based on professional medical judgment and standard care protocols.

Authorized Signature

Dr. Ahmed Hassan

General Practitioner

License No: 12345

Patient Signature

(Acknowledging receipt of services)

Thank you for choosing Alexandria Coastal Medical Center.

Your health is our priority. We hope you feel better soon.

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