Invoice Midwife in Ghana Accra –Free Word Template Download with AI
Registered Midwife: Mrs. Ama Serwaa Mensah, RN, RM
License No: NMA-GH-2024-8891
Address: 14 Independence Avenue, East Legon
City: Accra, Greater Accra Region, Ghana
Phone: +233 24 555 0199
Email: [email protected]
Invoice #: INV-2024-10-045
Date: October 24, 2024
Due Date: November 07, 2024
Status: Pending Payment
Bill To:
Client Name: Mr. Kwame Osei
On Behalf Of: Mrs. Efua Osei (Patient)
Address: House 22, Airport Residential Area
City: Accra, Ghana
Phone: +233 20 111 2233
NHIS Number: NHIS-9988776655
| # | Description of Midwifery Services | Quantity | Unit Price (GHS) | Total (GHS) |
|---|---|---|---|---|
| 1 |
Comprehensive Antenatal Care Package (Trimester 2 & 3) Includes routine physical examinations, fetal heart rate monitoring, blood pressure checks, urine analysis, and nutritional counseling provided at the clinic in Accra. |
6 | 150.00 | 900.00 |
| 2 |
Home Birth Attendance & Delivery Services Professional midwife attendance for natural delivery at the client's residence in East Legon. Includes sterile equipment setup, labor monitoring, and immediate post-delivery care for mother and newborn. |
1 | 1,200.00 | 1,200.00 |
| 3 |
Postnatal Care & Lactation Support Follow-up visits for the first two weeks post-delivery. Includes assessment of uterine involution, wound care (if applicable), breastfeeding support, and newborn health checks. |
4 | 100.00 | 400.00 |
| 4 |
Emergency Transport Coordination Administrative fee for coordinating ambulance transfer to Korle Bu Teaching Hospital in Accra should complications arise during labor. |
1 | 150.00 | 150.00 |
| 5 |
Medical Supplies & Consumables Provision of sterile gloves, delivery kit, umbilical cord clamps, antiseptics, and newborn care essentials used during the delivery process. |
1 | 250.00 | 250.00 |
| Subtotal: | GHS 2,900.00 |
| VAT (15%): | GHS 435.00 |
| Total Due: | GHS 3,335.00 |
Payment Instructions
Please make payment within 14 days of the invoice date. Payments can be made via Mobile Money (MTN/Vodafone/AirtelTigo) or Bank Transfer.
- Mobile Money: +233 24 555 0199 (Accra Premier Midwifery Services)
- Bank: Ecobank Ghana
- Account Name: Ama Serwaa Mensah
- Account Number: 1002345678901
- Branch: Accra Main Branch
Note: Please include the Invoice Number (INV-2024-10-045) as the reference for all payments.
Terms and Conditions
1. Regulatory Compliance: All services rendered by this midwife are in strict accordance with the regulations set forth by the Nursing and Midwifery Council of Ghana. The practitioner is fully licensed to operate within the Greater Accra Region.
2. NHIS Coverage: While some services may be covered under the National Health Insurance Scheme (NHIS), this invoice reflects the private payment portion or services rendered outside the NHIS cap. Please present your NHIS card for applicable claims processing.
3. Confidentiality: Patient information and medical records are kept strictly confidential in compliance with Ghanaian data protection laws.
4. Disputes: Any discrepancies regarding this invoice must be reported within 7 days of receipt. Late payments may incur a penalty fee of 2% per month.
5. Scope of Practice: This invoice covers midwifery care only. Any specialized medical interventions requiring a physician (e.g., C-sections, specialized pharmacology) will be billed separately by the respective hospital or doctor in Accra.
Authorized By:
Mrs. Ama Serwaa Mensah
Lead Midwife
Accra Premier Midwifery Services
Received By:
__________________________
Date: ____________________
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