Invoice Doctor General Practitioner in United Arab Emirates Dubai –Free Word Template Download with AI
Dubai Healthcare City
Building 27, Clinic 27-01
United Arab Emirates Dubai
P.O. Box 501234
License No: DHA-GP-2023-45678
TRN: 100123456700003
Tel: +971 4 123 4567
Email: [email protected]
INVOICE
Invoice Number: INV-2024-0892
Date of Issue: October 15, 2024
Date of Service: October 14, 2024
Due Date: October 30, 2024
Payment Status: Pending
VAT Notice: This Invoice is issued in accordance with the Federal Decree-Law No. (8) of 2017 on Value Added Tax and its Executive Regulations in the United Arab Emirates Dubai. A VAT rate of 5% is applied to all taxable supplies of medical services as per current UAE tax authority guidelines.From (Service Provider)
Dr. Ahmed Al-Mansoori
Doctor General Practitioner
Dubai Healthcare City
United Arab Emirates Dubai
Tax Registration Number (TRN): 100123456700003
Bill To (Patient / Insurance)
Mr. John Smith
Patient ID: PT-2024-5567
Address: Marina Gate, Tower B, Apt 1204
Dubai Marina, United Arab Emirates Dubai
Phone: +971 50 987 6543
Email: [email protected]
Insurance Provider: Daman Insurance
Policy Number: DAM-987654321
Group ID: GRP-45678
| # | Description of Medical Services | Code | Qty | Unit Price (AED) | Total (AED) |
|---|---|---|---|---|---|
| 1 |
General Practitioner Consultation Comprehensive initial consultation including medical history review, physical examination, and preliminary diagnosis provided by Doctor General Practitioner in Dubai. |
GP-001 | 1 | 350.00 | 350.00 |
| 2 |
Diagnostic Assessment Clinical assessment for respiratory symptoms including auscultation and vital signs monitoring. |
GP-005 | 1 | 150.00 | 150.00 |
| 3 |
Prescription and Medication Guidance Issuance of prescription for antibiotics and anti-inflammatory medication with dosage instructions. |
GP-010 | 1 | 75.00 | 75.00 |
| 4 |
Referral to Specialist Referral letter to Pulmonology Department at Dubai Hospital for further evaluation. |
GP-015 | 1 | 100.00 | 100.00 |
| 5 |
Medical Certificate Official sick leave certificate for 3 days as required by employer in United Arab Emirates Dubai. |
GP-020 | 1 | 125.00 | 125.00 |
| 6 |
Follow-up Consultation Scheduled follow-up appointment for medication review and symptom monitoring. |
GP-002 | 1 | 250.00 | 250.00 |
Payment Instructions
Please remit payment within 15 days from the date of this Invoice. Late payments may incur a penalty of 2% per month as per UAE commercial regulations.
Bank Transfer Details:
Bank Name: Emirates NBD
Account Name: Dr. Ahmed Al-Mansoori
Account Number: 1000 4567 8901 2345
IBAN: AE07 0331 2345 6789 0123 456
SWIFT/BIC: EBILAEAD
Branch: Dubai Healthcare City Branch
Other Payment Methods:
Credit/Debit Card: Visa, Mastercard, Amex accepted at clinic.
Cheque: Payable to "Dr. Ahmed Al-Mansoori".
Online Payment: www.drmansoori-dubai.ae/pay
Terms and Conditions
- This Invoice is issued by a licensed Doctor General Practitioner operating under the regulations of the Dubai Health Authority (DHA) in United Arab Emirates Dubai.
- All medical services provided are subject to the clinic's terms of service and patient consent forms signed at the time of consultation.
- Insurance claims must be submitted within 30 days of the date of service. Pre-authorization is required for certain procedures.
- VAT is charged in accordance with UAE Federal Tax Authority regulations. The Tax Registration Number (TRN) is provided above for verification.
- Any disputes regarding this Invoice should be raised within 7 days of receipt by contacting the clinic's billing department.
- This document serves as an official receipt for tax and insurance purposes in the United Arab Emirates Dubai.
- Medical records and consultation notes are confidential and protected under UAE healthcare privacy laws.
- Payment is expected in United Arab Emirates Dirhams (AED). Foreign currency payments will be converted at the prevailing exchange rate.
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