Invoice Doctor General Practitioner in Saudi Arabia Jeddah –Free Word Template Download with AI
Al-Rawdah District, King Fahd Road
Jeddah, Makkah Region
Saudi Arabia
P.O. Box: 12345
Phone: +966 12 345 6789
Email: [email protected]
Commercial Registration (CR): 1010203040
VAT Registration Number: 300123456700003
Health Ministry License: H-123456789
INVOICE
Invoice Number: INV-2023-8892
Date of Issue: October 24, 2023
Date of Service: October 24, 2023
Due Date: Upon Receipt
Patient Information| Name: Ahmed Mohammed Al-Fahad | National ID / Iqama: 1098765432 |
| Address: Al-Hamra District, Jeddah, Saudi Arabia | Phone: +966 50 123 4567 |
| Insurance Provider: Bupa Arabia (Policy: BUP-998877) | |
The following invoice details the professional medical services rendered by a licensed Doctor General Practitioner at our facility in Jeddah. These services are in accordance with the regulations set forth by the Saudi Commission for Health Specialties (SCFHS) and the Ministry of Health. The consultation included a comprehensive physical examination, medical history review, and diagnostic assessment.
| Item Code | Description | Quantity | Unit Price (SAR) | Total (SAR) |
|---|---|---|---|---|
| GP-001 | Initial Consultation with Doctor General Practitioner (30 mins) | 1 | 250.00 | 250.00 |
| GP-002 | Comprehensive Physical Examination | 1 | 150.00 | 150.00 |
| LAB-105 | Complete Blood Count (CBC) - Ordered by GP | 1 | 120.00 | 120.00 |
| LAB-108 | Lipid Profile Test - Ordered by GP | 1 | 180.00 | 180.00 |
| ADM-005 | Medical Certificate Issuance (Work/School) | 1 | 50.00 | 50.00 |
| Subtotal: | 750.00 SAR |
| VAT (15%): | 112.50 SAR |
| Total Amount Due: | 862.50 SAR |
Payment can be made via cash, credit card (Mada, Visa, MasterCard), or bank transfer. For bank transfers, please use the details below. Please quote the Invoice Number (INV-2023-8892) in the reference field.
- Bank Name: Al Rajhi Bank
- Account Name: Al-Shifa Medical Center
- IBAN: SA03 8000 0000 6080 1016 7519
- SWIFT Code: NBSASARJ
1. Validity: This invoice is valid for payment within 30 days from the date of issue. Late payments may incur a penalty in accordance with Saudi Arabian commercial laws.
2. Medical Services: The services provided by the Doctor General Practitioner are based on the best medical judgment at the time of consultation. This invoice does not guarantee specific medical outcomes.
3. VAT Compliance: This invoice complies with the Value Added Tax (VAT) regulations enforced by the Zakat, Tax and Customs Authority (ZATCA) in Saudi Arabia. The VAT rate applied is 15%.
4. Disputes: Any disputes regarding this invoice must be raised within 7 days of receipt. Please contact our billing department in Jeddah for clarification.
5. Privacy: Patient data is handled in strict accordance with the Personal Data Protection Law of the Kingdom of Saudi Arabia. Information shared with insurance providers is limited to what is necessary for claims processing.
6. Refunds: Refunds are processed only for services not rendered or in cases of billing errors, subject to approval by the clinic administration.
7. Jurisdiction: This agreement is governed by the laws of the Kingdom of Saudi Arabia. Any legal proceedings shall be subject to the jurisdiction of the courts in Jeddah.
Thank you for choosing Al-Shifa Medical Center for your healthcare needs in Jeddah. We are committed to providing high-quality general practice services to our community. ⬇️ Download as DOCX Edit online as DOCX
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