Invoice Nurse in United States Los Angeles –Free Word Template Download with AI
1234 Wilshire Boulevard, Suite 500
Los Angeles, CA 90017
United States
Phone: (213) 555-0199
Email: [email protected]
CA Seller's Permit: #03-1234567-89
Invoice Number: INV-2023-10-8842
Date Issued: October 24, 2023
Due Date: November 23, 2023
Payment Terms: Net 30 Days
BILL TO:
Westside Medical Center
Attn: Accounts Payable Department
1200 Westwood Blvd
Los Angeles, CA 90024
United States
SERVICE DETAILS:
Service Period: October 1, 2023 - October 31, 2023
Location: Westside Medical Center, Los Angeles, CA
Contract Reference: LA-MED-2023-Q4
PO Number: PO-99887766
| # | Description of Nursing Services | Rate | Hours | Tax | Amount |
|---|---|---|---|---|---|
| 1 |
Registered Nurse (RN) - Critical Care Unit Provision of specialized nursing care for ICU patients in Los Angeles. Includes hemodynamic monitoring, ventilator management, and administration of complex IV therapies. Staffing provided for 12-hour night shifts to ensure continuous patient safety and compliance with California nursing standards. |
$85.00 | 120 | $0.00 | $10,200.00 |
| 2 |
Travel Nurse - Emergency Department Temporary staffing solution for high-volume emergency intake. Services include triage, trauma assessment, and rapid response coordination. This invoice covers the premium rate for travel nurses deployed to Los Angeles facilities to address acute staffing shortages during the flu season. |
$95.00 | 80 | $0.00 | $7,600.00 |
| 3 |
Licensed Vocational Nurse (LVN) - General Ward Routine patient care services including vital signs monitoring, medication administration, and wound care. Services rendered at the Los Angeles branch facility. Includes documentation in electronic health records (EHR) and coordination with attending physicians. |
$55.00 | 160 | $0.00 | $8,800.00 |
| 4 |
Nurse Practitioner (NP) - Consultation Advanced practice nursing services for patient discharge planning and chronic disease management consultations. The Nurse Practitioner provided on-site evaluations to reduce readmission rates in accordance with United States healthcare regulations. |
$110.00 | 40 | $0.00 | $4,400.00 |
| 5 |
Overtime Nursing Staffing Emergency overtime hours for Registered Nurses during a critical staffing shortage event at the Los Angeles facility. Rates include the statutory overtime premium required by California labor laws for hours worked beyond the standard 8-hour shift. |
$127.50 | 24 | $0.00 | $3,060.00 |
| 6 |
Specialized Equipment & Supplies Provision of specialized nursing equipment including portable infusion pumps and monitoring devices used by our nursing staff during the billing period. |
- | - | $145.00 | $1,450.00 |
Payment Instructions:
Please remit payment via Electronic Funds Transfer (ACH) or Check.
Bank Name: Bank of America, Los Angeles Branch
Account Name: LA Premier Nursing Solutions LLC
Routing Number: 121000248
Account Number: 9876543210
Reference: Please include Invoice Number INV-2023-10-8842 in the memo line.
Check Payments: Please make checks payable to "LA Premier Nursing Solutions" and mail to the address listed in the header.
Terms and Conditions:
1. Payment Terms: Payment is due within 30 days of the invoice date. Late payments will incur a finance charge of 1.5% per month on the outstanding balance.
2. Disputes: Any discrepancies regarding this invoice must be reported in writing within 10 business days of receipt. Services not disputed within this timeframe will be considered accepted.
3. Compliance: All nursing services provided are compliant with the California Board of Registered Nursing regulations and federal healthcare standards.
4. Liability: LA Premier Nursing Solutions is not liable for indirect or consequential damages arising from the use of the services provided.
5. Governing Law: This invoice and the services described herein are governed by the laws of the State of California, United States.
Authorized By (Provider):
Sarah Jenkins, RN, MSN
Director of Operations
LA Premier Nursing Solutions
Received By (Client):
__________________________
Name & Title
Date
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