Invoice Doctor General Practitioner in Japan Tokyo –Free Word Template Download with AI
3-14-7 Shinjuku, Shinjuku-ku
Tokyo 160-0022, Japan
Tel: +81-3-5555-0199
Email: [email protected]
INVOICE
Invoice Number: INV-2023-10-045
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Payment Status: Pending
Bill To (Patient)
Mr. James Anderson
2-5-1 Roppongi, Minato-ku
Tokyo 106-0032, Japan
Phone: +81-90-1234-5678
Email: [email protected]
Dr. Kenji Tanaka
Licensed General Practitioner
Medical License No: 13-00-XXXX
Member of the Japan Medical Association
Tax ID: T1234567890123
This document serves as an official invoice for medical services rendered by a qualified Doctor General Practitioner at our facility located in Japan Tokyo. The following charges reflect the comprehensive care provided during your recent consultation, adhering to the standards of medical billing practices within the Tokyo metropolitan area.
| Description of Service | Date of Service | Quantity | Unit Price (JPY) | Total (JPY) |
|---|---|---|---|---|
|
Initial General Consultation Comprehensive physical examination and medical history review conducted by a Doctor General Practitioner. Includes assessment of vital signs and preliminary diagnosis. |
Oct 20, 2023 | 1 | 5,000 | 5,000 |
|
Diagnostic Imaging (Chest X-Ray) Radiological examination performed at our Tokyo facility to evaluate respiratory health. |
Oct 20, 2023 | 1 | 4,500 | 4,500 |
|
Blood Work Analysis Complete Blood Count (CBC) and metabolic panel analysis processed by our partner laboratory in Japan Tokyo. |
Oct 20, 2023 | 1 | 6,000 | 6,000 |
|
Follow-up Consultation Review of diagnostic results and formulation of treatment plan by the Doctor General Practitioner. |
Oct 23, 2023 | 1 | 3,500 | 3,500 |
|
Prescription Medication Dispensing of prescribed antibiotics and anti-inflammatory medication. |
Oct 23, 2023 | 1 | 2,500 | 2,500 |
|
Medical Certificate Issuance Official documentation for employment or insurance purposes, signed by the attending Doctor General Practitioner. |
Oct 23, 2023 | 1 | 1,500 | 1,500 |
Please remit payment within 30 days of the invoice date. Payments can be made via bank transfer to our account in Japan Tokyo or by credit card at the clinic reception.
Bank Name: Mizuho Bank, Shinjuku Branch
Account Name: Shinjuku Central Medical Clinic
Account Number: Ordinary 1234567
SWIFT Code: MHCBJPJT
This invoice is generated in accordance with the medical billing regulations of Japan. As a Doctor General Practitioner operating in Japan Tokyo, we are committed to transparency in all financial transactions. If you have health insurance coverage, please ensure your insurance card was presented at the time of service to apply the appropriate co-payment rates. Any discrepancies regarding the services listed should be reported to our billing department within 14 days.
For international patients, please note that this invoice may be required for reimbursement by your home country's health insurance provider. We recommend keeping a digital copy of this document for your records.
Authorized Signature
Dr. Kenji Tanaka
General Practitioner
Patient Acknowledgement
Signature: ___________________
Date: ___________________
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