Invoice Doctor General Practitioner in Vietnam Ho Chi Minh City –Free Word Template Download with AI
123 Nguyen Hue Boulevard, District 1
Ho Chi Minh City, Vietnam
Phone: +84 28 3822 1234
Email: [email protected]
Tax Code: 0312345678
INVOICE
Invoice Number: INV-2023-10-005
Date of Issue: October 24, 2023
Date of Service: October 24, 2023
Due Date: Upon Receipt
Bill To (Patient)
Mr. Nguyen Van A
45 Le Loi Street, District 1
Ho Chi Minh City, Vietnam
ID/Passport No: 001234567
Phone: +84 901 234 567
Dr. Tran Thi B
Licensed Doctor General Practitioner
License No: 12345/HCMC
Specialization: Internal Medicine & General Care
Location: Ho Chi Minh City
| # | Description of Service | Code | Unit Price (VND) | Total (VND) |
|---|---|---|---|---|
| 1 |
Initial Consultation - Doctor General Practitioner Comprehensive medical history review and physical examination conducted by a licensed Doctor General Practitioner in Ho Chi Minh City. Includes assessment of vital signs, general health evaluation, and preliminary diagnosis. |
GP-001 | 500,000 | 500,000 |
| 2 |
Diagnostic Blood Work Analysis Full blood count (CBC) and metabolic panel ordered by the Doctor General Practitioner to assess overall health status and detect potential underlying conditions. |
LAB-055 | 800,000 | 800,000 |
| 3 |
Electrocardiogram (ECG/EKG) Cardiac screening performed on-site at the clinic in Ho Chi Minh City to evaluate heart rhythm and electrical activity as part of the general practitioner's routine check-up. |
DIA-012 | 350,000 | 350,000 |
| 4 |
Prescription Medication Management Consultation regarding current medications, dosage adjustments, and prescription of new medication for hypertension management by the Doctor General Practitioner. |
GP-004 | 200,000 | 200,000 |
| 5 |
Health Education and Lifestyle Counseling Personalized advice on diet, exercise, and stress management provided by the Doctor General Practitioner to support long-term wellness in the context of Ho Chi Minh City's urban lifestyle. |
EDU-001 | 150,000 | 150,000 |
(Two Million Two Hundred Thousand Vietnamese Dong)
Payment InstructionsPayment is due immediately upon receipt of this invoice. Please use one of the following methods to settle the balance for services rendered by the Doctor General Practitioner:
- Bank Transfer: Vietcombank, Account Name: Saigon General Practice Clinic, Account No: 0071001234567, Branch: District 1, Ho Chi Minh City.
- Cash: Accepted at the clinic reception during business hours.
- Credit Card: Visa/Mastercard accepted via POS terminal at the clinic.
1. This invoice is issued in accordance with the regulations of the Ministry of Health and the Department of Health of Ho Chi Minh City.
2. All services listed were performed by a licensed Doctor General Practitioner qualified to practice in Vietnam.
3. Insurance claims should reference the invoice number and patient ID provided above.
4. Late payments may incur a penalty fee of 1% per month on the outstanding balance.
5. For any discrepancies or questions regarding this invoice, please contact our billing department within 14 days of the issue date.
6. Medical records and detailed reports are available upon request and may be subject to a separate administrative fee.
7. This document serves as an official receipt for tax and reimbursement purposes in Vietnam.
Authorized Signature
Dr. Tran Thi BDoctor General Practitioner
Saigon General Practice Clinic ⬇️ Download as DOCX Edit online as DOCX
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