Invoice Doctor General Practitioner in Malaysia Kuala Lumpur –Free Word Template Download with AI

Bill To (Patient)

Mr. Ahmad bin Razak
No. 15, Jalan Bukit Bintang
55100 Kuala Lumpur, Malaysia
IC No: 850101-10-1234
Phone: +6012-345 6789

Insurance / Third Party

Allianz Malaysia Berhad
Policy No: ALZ-MED-987654
Group ID: KL-CORP-001
Claim Reference: CLM-2023-5566

Dear Mr. Razak,

This document serves as the official Invoice for the medical consultation and related services provided by our Doctor General Practitioner at our clinic located in Malaysia Kuala Lumpur. As a primary care provider, our Doctor General Practitioner is dedicated to delivering comprehensive healthcare solutions tailored to your specific needs within the bustling environment of Kuala Lumpur.

The services detailed below were rendered on the date of visit. Please review the items carefully. This Invoice is required for your personal records and for submission to your insurance provider or employer for reimbursement purposes. In accordance with the medical billing standards in Malaysia Kuala Lumpur, all fees are listed in Malaysian Ringgit (MYR).

#	Description of Service	Date	Qty	Amount (MYR)
1	Consultation Fee - Doctor General Practitioner Initial consultation for general health assessment, including history taking, physical examination, and preliminary diagnosis. Conducted by Dr. Lim Wei Jie (M.B.B.S).	24/10/2023	1	150.00
2	Diagnostic Services - Blood Pressure Monitoring Routine cardiovascular screening performed during the visit to the Doctor General Practitioner.	24/10/2023	1	25.00
3	Prescription Medication Supply of prescribed antibiotics and pain relief medication dispensed at the clinic pharmacy in Kuala Lumpur.	24/10/2023	1	85.50
4	Medical Certificate Issuance Official Medical Certificate (MC) issued by the Doctor General Practitioner for 2 days of sick leave, valid for submission to employers in Malaysia.	24/10/2023	1	30.00
5	Referral Letter Referral to a specialist cardiologist in Kuala Lumpur, prepared by the Doctor General Practitioner for further investigation.	24/10/2023	1	40.00
6	Administrative Fee Processing fee for insurance claim documentation and filing.	24/10/2023	1	15.00

Subtotal: RM 345.50 Discount (Insurance Coverage): - RM 200.00 Service Tax (6%): RM 8.73 Total Due: RM 154.23 Payment Instructions

Payment is due within 30 days from the date of this Invoice. Please make payments via bank transfer to the following account:

Bank Name: Maybank Berhad
Account Name: KL Central Medical Clinic Sdn Bhd
Account Number: 5555 8888 9999
Branch: Kuala Lumpur City Centre
Reference: INV-2023-10-045

Alternatively, you may pay via credit card or e-wallet at the clinic reception in Malaysia Kuala Lumpur.

Terms and Conditions

This Invoice is issued by a registered medical practice in Malaysia Kuala Lumpur. All services are provided by a qualified Doctor General Practitioner licensed by the Malaysian Medical Council.
Please retain this document for your records. It serves as proof of payment and medical service rendered.
If you have any questions regarding the charges or the services provided by the Doctor General Practitioner, please contact our billing department at +603-2145 6789.
Late payments may incur a penalty fee of 2% per month on the outstanding balance.
Insurance claims must be submitted within 90 days of the date of service. Our clinic can assist with direct billing to approved insurance panels in Kuala Lumpur.
This Invoice is valid for tax purposes in Malaysia. The service tax charged is in accordance with the Royal Malaysian Customs Department regulations.

Thank you for choosing KL Central Medical Clinic for your healthcare needs. We are committed to providing you with the highest standard of care as your trusted Doctor General Practitioner in Malaysia Kuala Lumpur.

Authorized Signature
KL Central Medical Clinic Doctor General Practitioner
Dr. Lim Wei Jie ⬇️ Download as DOCX Edit online as DOCX

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