Invoice Occupational Therapist in Bangladesh Dhaka –Free Word Template Download with AI
House #45, Road #12, Dhanmondi Residential Area
Dhaka-1205, Bangladesh
Phone: +880 2 9123456 | Mobile: +880 1712-345678
Email: [email protected]
TIN: 123456789012 | VAT Reg: BD-VAT-987654321
Invoice Number: OT-DH-2024-0892
Date of Issue: October 24, 2024
Due Date: November 07, 2024
Payment Status: Pending
Bill To:
Mr. Rafiqul Islam
Flat #302, Green View Apartment
House #18, Road #7, Banani
Dhaka-1213, Bangladesh
Phone: +880 1812-987654
Email: [email protected]
Service Details:
Patient Name: Mr. Rafiqul Islam
Diagnosis: Post-stroke upper limb rehabilitation and fine motor skill restoration
Treatment Period: October 01, 2024 to October 24, 2024
Lead Occupational Therapist: Ms. Fatema Begum, B.Sc. OT, M.Sc. Rehabilitation Sciences
| # | Description of Occupational Therapy Services | Quantity | Unit Price (BDT) | Total (BDT) |
|---|---|---|---|---|
| 1 | Initial Comprehensive Occupational Therapy Assessment and Evaluation in Dhaka Clinic | 1 | 2,500.00 | 2,500.00 |
| 2 | Individual Occupational Therapy Sessions (60 minutes each) - Motor Skill Training | 12 | 1,800.00 | 21,600.00 |
| 3 | Adaptive Equipment Consultation and Training (Dhaka-based service) | 2 | 1,200.00 | 2,400.00 |
| 4 | Home Modification Assessment Report for Patient Residence in Banani, Dhaka | 1 | 3,500.00 | 3,500.00 |
| 5 | Customized Splinting and Orthotic Device Fabrication | 1 | 4,000.00 | 4,000.00 |
| 6 | Caregiver Training and Education Session (Family members included) | 2 | 1,000.00 | 2,000.00 |
| 7 | Progress Evaluation Report and Treatment Plan Adjustment | 1 | 1,500.00 | 1,500.00 |
| 8 | Therapeutic Activity Materials and Consumables Used During Sessions | 1 | 800.00 | 800.00 |
Amount in words: Thirty-Nine Thousand Four Hundred Forty-Nine Taka Only
Payment Instructions:
Please make payment within 14 days of the invoice date. We accept the following payment methods:
- Bank Transfer: BRAC Bank PLC, Dhanmondi Branch, Dhaka. Account Name: Dhaka Rehabilitation & OT Center Ltd. Account No: 1234567890123456. Routing/Swift Code: BRACBDDH
- bKash: Send Money to +880 1712-345678 (Merchant Account)
- Nagad: Send Money to +880 1812-345678 (Business Account)
- Cash: Accepted at our clinic in Dhanmondi, Dhaka during business hours (Saturday to Thursday, 9:00 AM to 6:00 PM)
Important: Please include the Invoice Number (OT-DH-2024-0892) as the payment reference for proper accounting and record-keeping.
Terms and Conditions:
1. This invoice is issued by Dhaka Rehabilitation & Occupational Therapy Center, a registered healthcare provider in Bangladesh, specializing in occupational therapy services in Dhaka.
2. All occupational therapy services provided are conducted by licensed and certified occupational therapists adhering to the standards set by the Bangladesh Occupational Therapy Association.
3. Payment is due within 14 days of the invoice date. Late payments may incur a penalty of 2% per month on the outstanding balance.
4. All prices are quoted in Bangladeshi Taka (BDT) and are inclusive of applicable taxes unless otherwise stated.
5. Any disputes regarding this invoice must be raised within 7 days of receipt. Please contact our billing department at [email protected] or call +880 2 9123456.
6. This invoice serves as an official receipt upon full payment and can be used for insurance claims or tax purposes in Bangladesh.
7. The occupational therapy treatment plan outlined in this invoice is based on the initial assessment and may be adjusted based on patient progress and clinical recommendations.
8. Our clinic is committed to providing high-quality, patient-centered occupational therapy services to individuals across Dhaka and surrounding areas in Bangladesh.
Authorized Signature
Md. Kamal Hossain
Finance Manager
Dhaka Rehabilitation & OT Center
Occupational Therapist Signature
Fatema Begum, B.Sc. OT
Lead Occupational Therapist
License No: BOT-2018-456
⬇️ Download as DOCX Edit online as DOCXCreate your own Word template with our GoGPT AI prompt:
GoGPT