Invoice Doctor General Practitioner in Israel Tel Aviv –Free Word Template Download with AI
Medical License No: 123456
VAT ID: 123456789
15 Rothschild Boulevard
Tel Aviv-Yafo, Israel 6688101
Tel: +972-3-555-1234
Email: [email protected]
INVOICE
Invoice Number: INV-2024-0892
Date of Issue: October 15, 2024
Due Date: November 15, 2024
Service Location: Israel Tel Aviv
Billed To:
Patient Name: David Levi National ID (Teudat Zehut): 987654321 Address: 22 HaYarkon Street, Apartment 4BTel Aviv-Yafo, Israel 6473201 Health Fund (Kupat Holim): Clalit Health Services
Member ID: CLT-456789012 Phone: +972-50-123-4567 Email: [email protected]
Service Details:
This invoice is issued by Dr. Sarah Cohen, a licensed Doctor General Practitioner operating in Israel Tel Aviv, for medical services rendered on October 10, 2024. The services were provided in accordance with the standards of the Israel Medical Association and local healthcare regulations. This document serves as an official record of the consultation and related procedures for both the patient and the relevant health insurance provider.
| Item # | Description of Service | Date | Quantity | Unit Price (ILS) | Total (ILS) |
|---|---|---|---|---|---|
| 1 | Initial Consultation with Doctor General Practitioner - Comprehensive health assessment, medical history review, and diagnosis. | Oct 10, 2024 | 1 | 350.00 | 350.00 |
| 2 | Physical Examination - Full body check-up including cardiovascular, respiratory, and abdominal systems. | Oct 10, 2024 | 1 | 200.00 | 200.00 |
| 3 | Diagnostic Interpretation - Review and analysis of blood test results and ECG performed in Israel Tel Aviv. | Oct 10, 2024 | 1 | 150.00 | 150.00 |
| 4 | Prescription and Treatment Plan - Detailed medication prescription and follow-up care instructions. | Oct 10, 2024 | 1 | 100.00 | 100.00 |
| 5 | Medical Certificate - Official documentation for employer or insurance purposes, issued by Doctor General Practitioner. | Oct 10, 2024 | 1 | 75.00 | 75.00 |
| 6 | Administrative Fee - Processing and documentation services related to the medical visit in Israel Tel Aviv. | Oct 10, 2024 | 1 | 50.00 | 50.00 |
| Subtotal: | 925.00 ILS |
| VAT (17%): | 157.25 ILS |
| Insurance Coverage (Clalit): | -400.00 ILS |
| Total Due: | 682.25 ILS |
Payment Instructions:
Payment is due within 30 days of the invoice date. Please make payments via bank transfer to the following account:
Bank: Bank Hapoalim
Branch: Tel Aviv Central
Account Number: 9101-234567-89
SWIFT Code: HAPoilmm
Please include the invoice number (INV-2024-0892) as a reference when making the payment. For any questions regarding this invoice or the services provided by the Doctor General Practitioner in Israel Tel Aviv, please contact our office directly.
Important Notes:
This invoice is issued in accordance with the Israeli Value Added Tax Law and the regulations set forth by the Ministry of Health. The services provided by Dr. Sarah Cohen, as a Doctor General Practitioner, are covered partially by the patient's health fund (Kupat Holim). The remaining balance is the patient's responsibility. This document is valid for reimbursement purposes and should be kept for your records.
In case of any discrepancies or errors in this invoice, please notify us within 14 days of receipt. We are committed to providing accurate and transparent billing for all medical services rendered in Israel Tel Aviv.
Authorized Signature:
_________________________
Dr. Sarah Cohen, MD
Doctor General Practitioner
Israel Tel Aviv
Create your own Word template with our GoGPT AI prompt:
GoGPT