Invoice Occupational Therapist in France Paris –Free Word Template Download with AI
Occupational Therapist (Ergothérapeute)
12 Rue de la République
75001 Paris, France
Tel: +33 1 42 60 00 00
Email: [email protected]
SIRET: 123 456 789 00012
N° Agrément: 75-123456789
Invoice Number: INV-2023-10-045
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Reference: Patient File #PL-8892
Billed To:
Monsieur Jean Dupont
45 Avenue des Champs-Élysées
75008 Paris, France
SS Number (Numéro de Sécurité Sociale): 1 85 04 75 100 123 45
Complementary Insurance: Mutuelle Santé Plus
| # | Description of Occupational Therapy Services | Date | Qty | Unit Price (€) | Total (€) |
|---|---|---|---|---|---|
| 1 |
Initial Assessment & Evaluation Comprehensive functional assessment of daily living activities (ADLs) and instrumental activities of daily living (IADLs). Evaluation of motor skills, cognitive function, and sensory processing within the context of the patient's home environment in Paris. |
Oct 01, 2023 | 1 | 85.00 | 85.00 |
| 2 |
Therapeutic Intervention Session One-on-one occupational therapy session focusing on upper limb rehabilitation and fine motor skill enhancement. Implementation of adaptive strategies for dressing and grooming. |
Oct 05, 2023 | 1 | 65.00 | 65.00 |
| 3 |
Therapeutic Intervention Session Cognitive rehabilitation exercises targeting memory, attention, and executive functioning. Training in the use of compensatory tools and environmental modifications. |
Oct 12, 2023 | 1 | 65.00 | 65.00 |
| 4 |
Home Adaptation Consultation On-site visit to the patient's residence in Paris to assess accessibility barriers. Recommendations for ergonomic adjustments and installation of safety equipment to promote independence. |
Oct 15, 2023 | 1 | 90.00 | 90.00 |
| 5 |
Provision of Assistive Devices Supply and fitting of specialized adaptive equipment (long-handled reacher and button hook) prescribed to facilitate independent self-care. |
Oct 18, 2023 | 1 | 45.00 | 45.00 |
| 6 |
Family Education & Training Session dedicated to educating family members on supporting the patient's occupational goals, handling techniques, and maintaining a therapeutic environment at home. |
Oct 20, 2023 | 1 | 60.00 | 60.00 |
Important Notes & Payment Terms:
This invoice represents professional services rendered by a licensed Occupational Therapist in accordance with the regulations of the French Ministry of Health. The services listed above are designed to restore, develop, or maintain the patient's ability to perform meaningful activities of daily life.
Payment Methods: Payment is expected within 30 days of the invoice date. Payments can be made via bank transfer (virement bancaire) or check payable to Dr. Sophie Laurent.
Bank Details:
Bank: BNP Paribas Paris Centre
IBAN: FR76 1234 5678 9012 3456 7890 123
BIC: BNPAFRPP
Insurance Reimbursement: Please note that while the French Social Security system (Assurance Maladie) may cover a portion of these occupational therapy fees based on the standard tariff (tarif de convention), any difference between the billed amount and the reimbursed amount is the responsibility of the patient or their complementary insurance provider (Mutuelle). This invoice should be submitted to your insurance provider for processing.
Legal Notice: In case of late payment, a penalty interest rate of 3 times the legal interest rate will be applied, along with a fixed indemnity of 40€ for recovery costs, in accordance with Article L441-6 of the French Commercial Code.
Dr. Sophie Laurent
Occupational Therapist
Signature & Stamp
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