Invoice Doctor General Practitioner in Russia Moscow –Free Word Template Download with AI
Licensed Medical Professional
Medical License No. ЛО-77-01-012345
Individual Entrepreneur (IP)
Invoice Number: INV-2023-10-089
Date of Issue: October 24, 2023
Due Date: November 07, 2023
Service Provider (Doctor General Practitioner)
Dr. Alexei Volkov
Private Medical Practice
Tverskaya Street, Building 15, Office 402
Moscow, Central Administrative Okrug
Russia, 125009
Phone: +7 (495) 123-45-67
Email: [email protected]
INN (Tax ID): 770123456789
KPP: 770101001
Bill To (Patient)
Mr. Ivan Petrov
Private Individual
Leninsky Avenue, Building 42, Apt 10
Moscow, South-Western Administrative Okrug
Russia, 119991
Phone: +7 (916) 987-65-43
Email: [email protected]
SNILS (Insurance ID): 123-456-789 00
| # | Description of Medical Services | Quantity | Unit Price (RUB) | Total (RUB) |
|---|---|---|---|---|
| 1 |
Initial Consultation with Doctor General Practitioner Comprehensive medical history review, physical examination, and preliminary diagnosis. Includes assessment of vital signs and general health status in accordance with Russian medical standards. |
1 | 4,500.00 | 4,500.00 |
| 2 |
Follow-up Consultation Review of laboratory results and adjustment of treatment plan. Detailed discussion regarding medication adherence and lifestyle modifications. |
1 | 3,000.00 | 3,000.00 |
| 3 |
Diagnostic Coordination Ordering and interpretation of blood work (CBC, Biochemistry) and ECG performed at partner clinic in Moscow. Administrative fee for medical oversight. |
1 | 1,500.00 | 1,500.00 |
| 4 |
Medical Certificate Issuance Preparation and official stamping of medical documentation required for employment or insurance purposes, compliant with Federal Law No. 323-FZ. |
2 | 800.00 | 1,600.00 |
| 5 |
Telemedicine Consultation Remote video consultation regarding minor symptoms and prescription renewal, conducted via secure encrypted platform. |
1 | 2,000.00 | 2,000.00 |
Payment Instructions & Legal Notice
This Invoice represents a formal request for payment for medical services rendered by a licensed Doctor General Practitioner located in Russia Moscow. Payment is expected within 14 days of the invoice date.
Bank Details for Transfer:
Bank Name: Sberbank of Russia
Beneficiary: IP Volkov A.V.
Account Number: 40802810000000012345
BIK: 044525225
Correspondent Account: 30101810400000000225
Legal Compliance:
All services provided adhere to the Federal Law of the Russian Federation "On the Basics of Health Protection of Citizens in the Russian Federation" (No. 323-FZ). This document serves as a financial record for both the patient and the medical provider. In case of any discrepancies regarding the services listed, please contact the clinic administration within 5 business days.
Privacy Policy:
Patient data used in this invoice is protected under Federal Law No. 152-FZ "On Personal Data". Information will not be shared with third parties without explicit consent, except as required by Russian law.
Authorized Signature
Dr. Alexei Volkov
Doctor General Practitioner
Patient Acknowledgement
Signature & Date
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