Invoice Midwife in Indonesia Jakarta –Free Word Template Download with AI
Professional Midwife Services
Jl. Sudirman No. 45, Menteng
Jakarta Pusat, Indonesia Jakarta 10310
Telp: +62 21 555 0199 | Email: [email protected]
NPWP: 01.234.567.8-901.000
Invoice Number: INV-JKT-MW-2023-0892
Date Issued: October 24, 2023
Due Date: November 07, 2023
Payment Status: Pending
Bill To:
Patient Name: Mrs. Siti Rahmawati
Address: Jl. Kemang Raya No. 12, Jakarta Selatan
City: Indonesia Jakarta 12730
Phone: +62 812 3456 7890
Email: [email protected]
Service Details:
Service Provider: Bidan S.Kep., Ners. Anisa Putri
Licensure No: IDI-KEP-JKT-998877
Service Period: September 01, 2023 - October 20, 2023
Location: Home Care & Clinic, Indonesia Jakarta
Referral: Dr. Budi Santoso, Obstetrician
| # | Description of Midwife Services | Quantity / Hours | Unit Price (IDR) | Total (IDR) |
|---|---|---|---|---|
| 1 |
Comprehensive Prenatal Assessment & Care Plan Initial consultation in Indonesia Jakarta including medical history review, physical examination, nutritional counseling, and personalized birth plan development. |
1 Session | 1,500,000 | 1,500,000 |
| 2 |
Monthly Prenatal Visits (3 Months) Routine monitoring of fetal development, blood pressure checks, urine analysis, and educational workshops on labor preparation conducted at the client's residence in Jakarta. |
3 Visits | 850,000 | 2,550,000 |
| 3 |
Ultrasound Coordination & Interpretation Support Assistance with scheduling diagnostic imaging at partner facilities in Indonesia Jakarta and providing preliminary interpretation of results to the expectant mother. |
2 Sessions | 400,000 | 800,000 |
| 4 |
Childbirth Education & Lamaze Training Specialized group and private sessions focusing on breathing techniques, pain management strategies, and partner involvement, tailored to the cultural context of Indonesia Jakarta. |
4 Hours | 600,000 | 2,400,000 |
| 5 |
24/7 On-Call Midwife Support (Final Month) Continuous availability for emergencies, questions, and guidance during the last trimester. Includes emergency transport coordination within Jakarta city limits. |
1 Month | 3,500,000 | 3,500,000 |
| 6 |
Postpartum Home Visit Package Three comprehensive visits following delivery to monitor maternal recovery, assist with breastfeeding initiation, and perform newborn health checks at the home in Indonesia Jakarta. |
3 Visits | 750,000 | 2,250,000 |
| 7 |
Administrative & Documentation Fees Preparation of medical records, birth certificates assistance, and coordination with local health authorities in Indonesia Jakarta. |
1 Lot | 500,000 | 500,000 |
Payment Instructions
Please remit payment within 14 days of the invoice date to avoid late fees. Payments can be made via bank transfer to the following account in Indonesia Jakarta:
Bank: Bank Central Asia (BCA)
Account Name: PT Perinatologi Jakarta Sejahtera
Account Number: 554-4321-9876
SWIFT Code: CENAIDJA
Note: Please include the Invoice Number (INV-JKT-MW-2023-0892) in the transfer description.
Terms and Conditions
- Validity: This invoice is valid for 30 days from the date of issue. Services rendered are based on the professional standards of midwifery practice in Indonesia.
- Late Payment: A late fee of 2% per month will be applied to any outstanding balance after the due date.
- Scope of Service: This invoice covers the specified midwife services. Hospital fees, surgical costs, or specialist consultations not directly provided by the midwife are billed separately by the respective institutions in Indonesia Jakarta.
- Confidentiality: All patient information is handled in strict accordance with Indonesian health data privacy regulations.
- Disputes: Any discrepancies regarding this invoice must be reported within 7 days of receipt. Please contact our billing department in Jakarta immediately.
- Currency: All amounts are denominated in Indonesian Rupiah (IDR). Foreign currency payments will be converted at the prevailing exchange rate on the day of transaction.
Authorized Signature:
Bidan S.Kep., Ners. Anisa PutriLead Midwife & Billing Officer
Perinatologi Jakarta Midwifery Center ⬇️ Download as DOCX Edit online as DOCX
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