Invoice Doctor General Practitioner in Sri Lanka Colombo –Free Word Template Download with AI
No. 45, Galle Road, Colombo 03
Sri Lanka Colombo
Tel: +94 11 234 5678
Email: [email protected]
INVOICE
Bill To
Mr. K. Jayawardena
12/3, Lake House Road
Colombo 07
Sri Lanka Colombo
NIC: 198567891234
Phone: +94 77 123 4567
Provider: Ceylon Insurance PLC
Policy Number: CI-MED-98765
Group ID: G-4567
Authorization Ref: AUTH-2024-112
This Invoice is issued in accordance with the Inland Revenue Act of Sri Lanka. All services rendered by this Doctor General Practitioner are subject to Value Added Tax (VAT) at the prevailing rate of 18% as mandated by the Sri Lanka Revenue Authority. Please retain this document for your personal medical records and insurance claims. Description of Medical Services
| # | Service Description | Date | Amount (LKR) |
|---|---|---|---|
| 1 |
Initial Consultation - Doctor General Practitioner Comprehensive health assessment conducted by Dr. A. Perera. Includes detailed medical history review, physical examination, and preliminary diagnosis. This service reflects the standard of care expected from a qualified Doctor General Practitioner in Sri Lanka Colombo. |
Oct 24, 2024 | 5,000.00 |
| 2 |
Diagnostic Blood Work Panel Full Blood Count (FBC), Lipid Profile, and Fasting Blood Glucose. Samples collected at our Sri Lanka Colombo clinic and processed by certified laboratory partners. Essential for accurate diagnosis by the Doctor General Practitioner. |
Oct 24, 2024 | 3,500.00 |
| 3 |
Electrocardiogram (ECG) 12-lead ECG performed to assess cardiac rhythm and function. Conducted on-site at the Colombo Medical Centre under the supervision of the Doctor General Practitioner. |
Oct 24, 2024 | 2,000.00 |
| 4 |
Follow-up Consultation Review of diagnostic results and formulation of treatment plan. The Doctor General Practitioner provided detailed explanations regarding lifestyle modifications and medication adherence. |
Oct 25, 2024 | 3,000.00 |
| 5 |
Prescription Medication Dispensing Supply of prescribed pharmaceuticals including antihypertensives and vitamins. Medications sourced from licensed pharmacies in Sri Lanka Colombo and dispensed directly by the clinic. |
Oct 25, 2024 | 4,200.00 |
| 6 |
Medical Certificate Issuance Official medical certificate for employment purposes, signed and stamped by the Doctor General Practitioner. Valid for use within Sri Lanka Colombo and recognized by local employers. |
Oct 25, 2024 | 1,500.00 |
Please make payment within 14 days of the Invoice date. Payments can be made via the following methods accepted in Sri Lanka Colombo:
- Bank Transfer: Commercial Bank of Ceylon, Account Name: Colombo Medical Centre, Account No: 1234567890123
- Credit/Debit Card: Visa, Mastercard accepted at clinic reception
- Cash: Sri Lankan Rupees (LKR) accepted at our Colombo 03 branch
For insurance claims, please submit this Invoice along with the medical reports to your provider. Our Doctor General Practitioner is registered with major insurance companies operating in Sri Lanka Colombo.
Terms and Conditions- This Invoice is valid for 30 days from the date of issue.
- All services provided by the Doctor General Practitioner are subject to professional medical standards.
- In case of disputes, the jurisdiction shall be the courts of Sri Lanka Colombo.
- Medical records are confidential and protected under Sri Lankan law.
- Failure to pay within the due date may result in a late fee of 2% per month.
- This document serves as an official receipt upon payment confirmation.
Thank you for trusting our Doctor General Practitioner with your healthcare needs. We are committed to providing high-quality medical services to the community of Sri Lanka Colombo. For any queries regarding this Invoice, please contact our billing department at +94 11 234 5678 or visit our clinic during business hours.
Authorized Signature
Dr. A. Perera
Doctor General Practitioner
Patient Acknowledgment
_______________________
Date: _________________
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