Invoice Doctor General Practitioner in Ivory Coast Abidjan –Free Word Template Download with AI
Medical Center of Cocody
Boulevard Latrille, Angré
Abidjan, Ivory Coast
Phone: +225 27 22 44 55 66
Email: [email protected]
Order No. (N° Ordre): 123456789
INVOICE
Invoice Date: October 24, 2023
Invoice Number: INV-2023-0042
Due Date: Upon Receipt
Patient Information| Name: Marie-Claire Diallo | Date of Birth: 15/05/1985 |
| Address: Quartier Résidentiel, Marcory, Abidjan | Phone: +225 07 08 09 10 11 |
| Insurance Provider: CNPS / Mutualité | Policy Number: MUT-99887766 |
The following invoice details the medical consultations and treatments provided by the undersigned Doctor General Practitioner located in Abidjan, Ivory Coast. These services adhere to the national medical tariff guidelines and professional standards established by the Order of Physicians of Ivory Coast.
| Ref | Description of Service | Date | Qty | Unit Price (XOF) | Total (XOF) |
|---|---|---|---|---|---|
| 01 | General Medical Consultation (Consultation Générale) | 24/10/2023 | 1 | 5,000 | 5,000 |
| 02 | Physical Examination & Vitals Assessment | 24/10/2023 | 1 | 2,000 | 2,000 |
| 03 | Prescription of Medication (Antibiotics & Analgesics) | 24/10/2023 | 1 | 15,000 | 15,000 |
| 04 | Medical Certificate Issuance | 24/10/2023 | 1 | 3,000 | 3,000 |
| 05 | Administrative Fee for Insurance Processing | 24/10/2023 | 1 | 1,000 | 1,000 |
Subtotal: 26,000 XOF
VAT (18%): 4,680 XOF
Grand Total: 30,680 XOF
(Thirty Thousand, Six Hundred and Eighty West African CFA Francs)
Payment InstructionsPayment for this invoice is due immediately. As a Doctor General Practitioner operating in Abidjan, we accept the following payment methods common in Ivory Coast:
- Cash: West African CFA Francs (XOF) accepted at the clinic.
- Mobile Money: Orange Money or MTN Mobile Money transfers.
- Bank Transfer: Ecobank or BICICI (Bank of Ivory Coast).
1. Validity: This invoice is valid for 30 days from the date of issuance. It serves as the official receipt for medical services rendered by the Doctor General Practitioner listed above.
2. Insurance Claims: This document is formatted to meet the requirements of insurance providers in Ivory Coast, including CNPS and private mutualities. Please retain this original invoice for reimbursement purposes.
3. Confidentiality: In accordance with medical ethics and Ivorian law, all patient information contained within this invoice is strictly confidential and protected.
4. Disputes: Any discrepancies regarding the charges listed must be reported within 7 days of receipt.
Doctor General Practitioner
Dr. Jean-Marc Kouassi
Abidjan, Ivory Coast
Patient Signature
Acknowledging receipt of services
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