Invoice Doctor General Practitioner in Russia Saint Petersburg –Free Word Template Download with AI
191025, Russia, Saint Petersburg
Nevsky Prospekt, 120, Building 3
Tel: +7 (812) 555-01-99
Email: [email protected]
INVOICE
Invoice Number: INV-SPB-2024-0892
Date of Issue: October 24, 2024
Due Date: November 07, 2024
Payment Reference: GP-CONSULT-2024-Q4
Bill To:Patient Name: Ivan Petrovich Sokolov
Address: 197110, Russia, Saint Petersburg
Vasileostrovsky District, 10th Line, 45, Apt. 12
Phone: +7 (921) 123-45-67
Email: [email protected]
Policy Number: POL-RU-SPB-778899
Service Provider:Doctor: Dr. Elena Mikhailovna Volkova
Specialty: Doctor General Practitioner
Licence No: LO-78-01-001234
Registration: Ministry of Health of the Russian Federation
Practice Location: Neva Medical Center, Saint Petersburg
Description of Medical Services RenderedThe following invoice details the professional medical services provided by a qualified Doctor General Practitioner at our clinic located in Russia Saint Petersburg. These services are in accordance with the standards set by the Federal Law "On the Fundamentals of Health Protection of Citizens in the Russian Federation" and the regulations governing private medical practice in the Leningrad Region.
| # | Service Description | Date | Qty | Unit Price (RUB) | Total (RUB) |
|---|---|---|---|---|---|
| 1 |
Initial Consultation - Doctor General Practitioner Comprehensive health assessment, medical history review, and physical examination conducted by Dr. Volkova. Includes diagnostic evaluation and preliminary treatment plan formulation. |
Oct 20, 2024 | 1 | 3,500.00 | 3,500.00 |
| 2 |
Follow-up Consultation - Doctor General Practitioner Review of test results, adjustment of treatment protocol, and patient education regarding medication adherence. Conducted at our Saint Petersburg clinic. |
Oct 22, 2024 | 1 | 2,500.00 | 2,500.00 |
| 3 |
Diagnostic Blood Panel Analysis Complete blood count (CBC), lipid profile, and glucose tolerance test. Samples collected and processed at our accredited laboratory in Russia Saint Petersburg. |
Oct 20, 2024 | 1 | 4,200.00 | 4,200.00 |
| 4 |
Electrocardiogram (ECG) Examination Standard 12-lead ECG performed to assess cardiac function as part of the general health checkup. Interpreted by the attending Doctor General Practitioner. |
Oct 20, 2024 | 1 | 1,800.00 | 1,800.00 |
| 5 |
Prescription and Medication Counseling Detailed explanation of prescribed medications, potential side effects, and dosage instructions. Includes printed prescription valid for pharmacies in Saint Petersburg. |
Oct 22, 2024 | 1 | 800.00 | 800.00 |
| 6 |
Medical Certificate Issuance Official medical certificate confirming consultation and fitness for work, issued in compliance with Russian Federation regulations. |
Oct 22, 2024 | 1 | 1,200.00 | 1,200.00 |
- Currency: All amounts are quoted in Russian Rubles (RUB).
- Payment Deadline: Payment is due within 14 days from the date of invoice issuance.
- Accepted Payment Methods: Bank transfer, credit/debit card, or cash at our clinic in Saint Petersburg.
- Bank Details:
Bank Name: Sberbank of Russia
Account Name: Neva Medical Center LLC
BIC: 044525225
Account Number: 40702810938000123456
Correspondent Account: 30101810400000000225 - Late Payment: A late fee of 0.1% per day will be applied to overdue amounts.
- Medical Records: All medical records and test results are stored securely in accordance with Federal Law No. 152-FZ "On Personal Data".
- Doctor General Practitioner Services: All consultations are conducted by licensed professionals registered with the Ministry of Health of the Russian Federation.
- Location: Services rendered at our clinic located in Russia Saint Petersburg, Nevsky Prospekt, 120.
- Questions: For any inquiries regarding this invoice, please contact our billing department at [email protected] or call +7 (812) 555-01-99.
Authorized Signature
Dr. Elena Mikhailovna Volkova
Doctor General Practitioner
Accepted By (Patient)
Ivan Petrovich Sokolov
Date: _______________
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