Invoice Doctor General Practitioner in Tanzania Dar es Salaam –Free Word Template Download with AI
Licensed Medical Practitioner
Medical Council of Tanzania Registration No: MCT/2018/45892
VAT Registration No: TRN 123-456-789-000
INVOICE
Invoice Number: INV-2024-0847
Date of Issue: 15th January 2024
Due Date: 30th January 2024
Payment Status: PENDING
From (Service Provider)
Dr. Amina Juma, MBChB, MMed (Family Medicine)
Doctor General Practitioner
Upanga Medical Centre, 3rd Floor
Sam Nujoma Road, Upanga West
Dar es Salaam, Tanzania
Phone: +255 22 211 4567
Mobile: +255 754 123 456
Email: [email protected]
Bill To (Patient/Client)
Mr. Joseph Mwangi Kamau
Plot No. 45, Masaki Peninsula
Haile Selassie Road
Dar es Salaam, Tanzania
Phone: +255 713 987 654
Email: [email protected]
National ID No: TZ-1985-4567890
Invoice Description
This Invoice document serves as an official request for payment for medical services rendered by a qualified Doctor General Practitioner located in Tanzania Dar es Salaam. The services detailed below were provided in accordance with the professional standards set by the Medical Council of Tanzania and the healthcare regulations governing private medical practice in the United Republic of Tanzania. All consultations, examinations, and treatments were conducted at the Upanga Medical Centre facility in Dar es Salaam, ensuring compliance with local health and safety protocols.
Medical Services Rendered
| # | Description of Service | Date of Service | Quantity | Unit Price (TZS) | Total (TZS) |
|---|---|---|---|---|---|
| 1 |
Initial Consultation - Doctor General Practitioner Comprehensive medical history review, physical examination, and preliminary diagnosis conducted by a licensed Doctor General Practitioner in Tanzania Dar es Salaam. |
10/01/2024 | 1 | 75,000 | 75,000 |
| 2 |
Follow-up Consultation Review of test results and adjustment of treatment plan by the Doctor General Practitioner. |
12/01/2024 | 1 | 50,000 | 50,000 |
| 3 |
Complete Blood Count (CBC) Test Laboratory analysis ordered by the Doctor General Practitioner to assess overall health status. |
10/01/2024 | 1 | 35,000 | 35,000 |
| 4 |
Liver Function Test Panel Diagnostic blood test to evaluate liver health as recommended by the Doctor General Practitioner. |
10/01/2024 | 1 | 45,000 | 45,000 |
| 5 |
Prescription Medication Dispensing Antibiotics and supportive medications prescribed and dispensed by the Doctor General Practitioner's clinic pharmacy. |
12/01/2024 | 1 | 65,000 | 65,000 |
| 6 |
Medical Certificate Issuance Official medical certificate for sick leave issued by the Doctor General Practitioner in Tanzania Dar es Salaam. |
12/01/2024 | 1 | 20,000 | 20,000 |
| 7 |
Health Education and Lifestyle Counseling Personalized dietary and exercise recommendations provided by the Doctor General Practitioner. |
12/01/2024 | 1 | 30,000 | 30,000 |
(Three Hundred Sixty-One Thousand Six Hundred Tanzanian Shillings Only)
Payment Instructions
Currency: Tanzanian Shillings (TZS)
Payment Deadline: Please settle this Invoice by 30th January 2024 to avoid late payment penalties.
Bank Transfer Details:
Bank Name: CRDB Bank Tanzania Ltd
Branch: Upanga Branch, Dar es Salaam
Account Name: Dr. Amina Juma Medical Practice
Account Number: 0123456789012
SWIFT Code: CRDBTZDX
M-Pesa / Tigo Pesa: +255 754 123 456 (Dr. Amina Juma)
Reference: Please use Invoice Number INV-2024-0847 as payment reference.
Terms and Conditions
1. This Invoice is issued by a registered Doctor General Practitioner operating legally within Tanzania Dar es Salaam under the supervision of the Medical Council of Tanzania.
2. All medical services listed above were personally rendered or directly supervised by the Doctor General Practitioner named on this Invoice.
3. Payment is expected within 15 days from the date of this Invoice. Late payments may incur a penalty of 2% per week on the outstanding balance.
4. In case of any discrepancies regarding the services rendered or charges applied, please contact the Doctor General Practitioner's office within 7 days of receiving this Invoice.
5. This Invoice serves as an official receipt upon confirmation of payment and can be used for insurance claims or tax purposes in Tanzania.
6. All personal health information shared during consultations is kept strictly confidential in accordance with the Tanzania Data Protection Act and medical ethics standards.
7. The Doctor General Practitioner reserves the right to suspend further medical services if payment for this Invoice is not received by the due date.
8. This Invoice is valid only when signed and stamped by the authorized Doctor General Practitioner or clinic administrator.
CLINICSTAMP
Official Clinic Stamp
Dr. Amina Juma, MBChBDoctor General Practitioner
Date: 15/01/2024 ⬇️ Download as DOCX Edit online as DOCX
Create your own Word template with our GoGPT AI prompt:
GoGPT