Invoice Doctor General Practitioner in Nepal Kathmandu –Free Word Template Download with AI
General Practitioner & Family Physician
Thamel, Ward No. 4, Kathmandu Metropolitan City
Kathmandu, Nepal - 44600
Phone: +977-1-4234567 | Mobile: +977-9841234567
Email: [email protected]
MOH Registration No: MOH/NP/2075/12345
PAN/VAT No: 123456789
Bill To:Patient Name: Sunita Gurung
Address: House No. 45, New Baneshwor
Kathmandu, Nepal - 44600
Phone: +977-9861234567
National ID: 12-34-567890
Insurance: Nepal Life Insurance Co. Ltd.
Policy No: NLI-2024-56789
Pay From:Shanti Medical Clinic
Dr. Rajesh Sharma, MBBS, MD
General Practitioner
Thamel, Kathmandu, Nepal
Bank: Nepal Bank Limited
Branch: Thamel Branch
Account No: 0123456789012
Routing Code: NBL000001
Medical Services Rendered| # | Description of Service | Date | Qty | Unit Price (NPR) | Total (NPR) |
|---|---|---|---|---|---|
| 1 | Initial Consultation - General Practitioner Assessment | 2024-03-15 | 1 | 1,500.00 | 1,500.00 |
| 2 | Comprehensive Physical Examination | 2024-03-15 | 1 | 1,000.00 | 1,000.00 |
| 3 | Blood Pressure Monitoring & Cardiovascular Assessment | 2024-03-15 | 1 | 500.00 | 500.00 |
| 4 | Complete Blood Count (CBC) Test | 2024-03-15 | 1 | 800.00 | 800.00 |
| 5 | Blood Glucose Level Test (Fasting) | 2024-03-15 | 1 | 400.00 | 400.00 |
| 6 | Lipid Profile Test | 2024-03-15 | 1 | 1,200.00 | 1,200.00 |
| 7 | Thyroid Function Test (TSH, T3, T4) | 2024-03-15 | 1 | 1,500.00 | 1,500.00 |
| 8 | Electrocardiogram (ECG) - 12 Lead | 2024-03-15 | 1 | 1,000.00 | 1,000.00 |
| 9 | Medical Report Preparation & Documentation | 2024-03-15 | 1 | 500.00 | 500.00 |
| 10 | Prescription Medications (Antibiotics, Antihypertensives) | 2024-03-15 | 1 | 2,500.00 | 2,500.00 |
| 11 | Follow-up Consultation Fee (Scheduled for 2024-03-22) | 2024-03-22 | 1 | 1,000.00 | 1,000.00 |
| 12 | Health Education & Lifestyle Counseling Session | 2024-03-15 | 1 | 750.00 | 750.00 |
Amount Paid: NPR 6,957.48
Payment Method: Cash / eSewa / Khalti / Bank Transfer
Transaction ID: TXN-2024-03-15-789456
Payment Status: PAID IN FULL
Payment Date: 2024-03-15
Terms, Conditions & Important Notes- This Invoice is issued by Dr. Rajesh Sharma, a licensed General Practitioner practicing in Kathmandu, Nepal, in accordance with the Medical Council of Nepal regulations.
- All medical services provided are based on professional medical judgment and standard clinical practices followed in Nepal.
- Payment is due within 7 days from the date of this Invoice. Late payments may incur a 2% monthly interest charge.
- Insurance claims must be submitted within 30 days of the service date with all required documentation.
- This Invoice serves as an official receipt for tax purposes under the Inland Revenue Department of Nepal.
- Patients are responsible for verifying their insurance coverage prior to receiving services.
- Any disputes regarding this Invoice should be raised within 15 days of receipt.
- Medical records and test results are confidential and protected under Nepal's healthcare privacy laws.
- Follow-up appointments must be scheduled in advance. Cancellations should be made at least 24 hours prior.
- Prescriptions are valid for 30 days from the date of issuance as per Nepal's pharmaceutical regulations.
Dr. Rajesh Sharma, MBBS, MD
General Practitioner
Shanti Medical Clinic, Kathmandu Patient Signature
Sunita Gurung
Date: 2024-03-15 ⬇️ Download as DOCX Edit online as DOCX
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