Invoice Midwife in Belgium Brussels –Free Word Template Download with AI
Lead Midwife: Sarah Van den Berg, MSc
12 Rue de la Santé / Gezondheidstraat 12
1000 Brussels, Belgium
Email: [email protected]
Phone: +32 2 555 0199
VAT Number: BE 0892.345.678
Registration: OCMW Brussels / Mutualité Sociale
Invoice #: INV-2023-10-042
Date: October 24, 2023
Due Date: November 24, 2023
Reference: Pregnancy Care Package - Third Trimester
Bill To:
Client Name: Elena Rossi
45 Avenue Louise / Louise-laan 45
1050 Brussels, Belgium
Insurance: Mutualité Chrétienne / Christelijke Mutualiteit
Policy Number: MC-99887766
Service Period:
Start Date: September 01, 2023
End Date: October 20, 2023
Location: Home Visits in Brussels & Clinic Consultations
Language: English / French
| # | Description of Midwifery Services | Quantity | Unit Price (EUR) | Total (EUR) |
|---|---|---|---|---|
| 1 |
Comprehensive Antenatal Consultation (Brussels Home Visit) Detailed physical examination, fetal heart rate monitoring, and blood pressure assessment conducted at the client's residence in Brussels. Includes discussion of birth plan preferences and nutritional guidance tailored to the Belgian healthcare context. |
2 | 85.00 | 170.00 |
| 2 |
Prenatal Education Workshop Participation Facilitation and attendance of a group session focused on labor preparation, pain management techniques, and newborn care. Held at the Brussels Community Health Center. This service aligns with the educational standards required for midwives practicing in the Brussels-Capital Region. |
1 | 45.00 | 45.00 |
| 3 |
Ultrasound Coordination and Interpretation Support Administrative coordination for the mandatory 20-week anomaly scan within the Brussels hospital network. Includes pre-scan counseling and post-scan explanation of results to ensure informed consent and understanding of fetal development. |
1 | 30.00 | 30.00 |
| 4 |
Psychosocial Support and Counseling Session One-on-one session addressing anxiety regarding childbirth and postpartum adjustment. This service is critical for maintaining maternal mental health and is provided in accordance with the ethical guidelines for midwives in Belgium. |
1 | 60.00 | 60.00 |
| 5 |
Birth Plan Development and Hospital Liaison Drafting a personalized birth plan and communicating with the attending obstetrician at the designated Brussels hospital. Ensures continuity of care and respects the client's wishes within the legal framework of Belgian maternity care. |
1 | 50.00 | 50.00 |
| 6 |
Administrative and Billing Management Preparation of necessary documentation for reimbursement by the Belgian National Institute for Health and Disability Insurance (RIZIV/INAMI). Includes filing of standard midwifery codes applicable in the Brussels region. |
1 | 25.00 | 25.00 |
Payment Instructions & Notes:
Please remit payment via bank transfer to the following account within 30 days of the invoice date.
Bank: KBC Brussels
IBAN: BE68 5390 0754 7032
BIC: KREDBEBB
Reference: INV-2023-10-042
Reimbursement Information: As a registered midwife in Belgium, I have submitted the eligible portion of these fees directly to your mutual insurance fund. The amount deducted above is an estimate based on standard Brussels reimbursement rates. You may receive a separate confirmation from your insurer.
Service Guarantee: Brussels Holistic Midwifery is committed to providing safe, evidence-based, and compassionate care. All services rendered comply with the Royal Decree regulating the profession of midwife in Belgium.
This invoice serves as an official record of midwifery services provided in the Brussels-Capital Region. By accepting these services, the client acknowledges that the midwife operates under the supervision of the Belgian Order of Midwives. In the event of a medical emergency requiring hospitalization, the midwife will facilitate the transfer of care to the appropriate obstetric team in Brussels. This document is valid for tax purposes and insurance claims within the European Union. Please retain this invoice for your personal records. For any disputes regarding billing or services, please contact the office directly before escalating to the regional health authority.
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