Invoice Midwife in Zimbabwe Harare –Free Word Template Download with AI
Registered Midwife: Sarah M. Chikumbutso, RN, RM
Registration Number: ZNMC/2018/4592
Address: 45 Samora Machel Avenue, Borrowdale
City: Harare, Zimbabwe
Phone: +263 77 123 4567
Email: [email protected]
Invoice Number: INV-2024-0892
Date Issued: October 15, 2024
Due Date: October 30, 2024
Payment Status: Pending
Bill To:
Patient Name: Tendai Moyo
Address: 122 Robert Mugabe Road, Avondale
City: Harare, Zimbabwe
Phone: +263 71 987 6543
Insurance Provider: Medscheme Zimbabwe
Policy Number: MS-ZW-8842190
Group Number: G-4421
Referral Code: REF-HRE-2024-112
Midwifery Services Rendered in Harare, Zimbabwe
| # | Description of Midwifery Service | Date of Service | Quantity | Unit Price (USD) | Total (USD) |
|---|---|---|---|---|---|
| 1 | Initial Prenatal Consultation & Risk Assessment conducted at Harare Central Clinic | 2024-09-01 | 1 | 45.00 | 45.00 |
| 2 | Comprehensive Antenatal Care Package (4 visits) including fetal monitoring and nutritional counseling | 2024-09-15 | 4 | 35.00 | 140.00 |
| 3 | Ultrasound Coordination & Interpretation Support at Harare Private Imaging Center | 2024-09-20 | 1 | 25.00 | 25.00 |
| 4 | Home Visit for High-Risk Pregnancy Monitoring in Borrowdale, Harare | 2024-10-05 | 2 | 50.00 | 100.00 |
| 5 | Childbirth Education Workshop Attendance (Group Session at Harare Community Health Center) | 2024-10-08 | 1 | 30.00 | 30.00 |
| 6 | Emergency On-Call Midwifery Availability Fee (24/7 coverage during final trimester) | 2024-10-01 | 1 | 75.00 | 75.00 |
| 7 | Postnatal Care Consultation & Newborn Assessment at Patient's Residence in Harare | 2024-10-12 | 1 | 40.00 | 40.00 |
| 8 | Medical Documentation & Referral Coordination with Harare Hospitals | 2024-10-14 | 1 | 20.00 | 20.00 |
| Subtotal: | $475.00 |
| Value Added Tax (VAT) 15%: | $71.25 |
| Insurance Adjustment: | -$150.00 |
| Total Amount Due: | $396.25 |
Payment Instructions for Harare, Zimbabwe
Bank Transfer Details:
Bank Name: CBZ Bank Zimbabwe
Branch: Harare CBD
Account Name: Harare Maternity & Midwifery Services (Pvt) Ltd
Account Number: 123-456789-0
SWIFT Code: CBZZZWHA
Mobile Money: EcoCash / OneMoney accepted. Send to +263 77 123 4567. Reference: Invoice Number.
Cash Payments: Accepted at our Borrowdale clinic during business hours (Monday-Friday, 8:00 AM - 5:00 PM).
Please include your invoice number as payment reference. All payments are processed in United States Dollars (USD) as per Zimbabwean financial regulations.
Terms & Conditions
1. Payment is due within 15 days of invoice date. Late payments may incur a 5% monthly interest charge.
2. This invoice covers midwifery services rendered in accordance with the Zimbabwe Nursing Council standards.
3. Insurance claims must be submitted within 30 days of service. Our office will assist with documentation.
4. For emergency midwifery services outside scheduled hours, additional fees may apply as outlined in our service agreement.
5. All medical records and documentation remain the property of Harare Maternity & Midwifery Services.
6. Disputes regarding this invoice must be raised in writing within 7 days of receipt.
7. This invoice is valid for services provided within Harare, Zimbabwe. Travel fees may apply for services outside the city limits.
Authorized By:
Sarah M. Chikumbutso, RN, RM
Lead Midwife & Practice Owner
Harare Maternity & Midwifery Services
Signature: _________________________
Date: October 15, 2024
Received By:
Patient/Guarantor Name:
Signature: _________________________
Date: _________________________
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