Invoice Occupational Therapist in Israel Jerusalem –Free Word Template Download with AI
Lead Occupational Therapist: Sarah Cohen, M.Sc., OTR/L
12 King David Street, Talpiot
Jerusalem, 9410000, Israel
VAT ID (HPR): 517000000
Email: [email protected] | Phone: +972-2-555-0199
Invoice #: INV-2023-10-045
Date: October 24, 2023
Due Date: November 24, 2023
Bill To:
Mr. David Levi
45 Emek Refaim Street
Bat Yam, 6070000, Israel
Client ID: 305-123456-7
Insurance Provider: Maccabi Healthcare Services
Policy Number: MAC-99887766
| # | Description of Occupational Therapy Services | Date | Qty (Sessions) | Unit Price (ILS) | Total (ILS) |
|---|---|---|---|---|---|
| 1 | Initial Comprehensive Assessment: Evaluation of motor skills, cognitive function, and daily living activities (ADLs) conducted at the Jerusalem clinic. Includes detailed report for insurance approval. | Oct 01, 2023 | 1 | 450.00 | 450.00 |
| 2 | Individual Occupational Therapy Session (Post-Stroke Rehab): Focus on upper limb rehabilitation, fine motor coordination, and sensory integration. | Oct 05, 2023 | 1 | 350.00 | 350.00 |
| 3 | Individual Occupational Therapy Session (Post-Stroke Rehab): Focus on upper limb rehabilitation, fine motor coordination, and sensory integration. | Oct 12, 2023 | 1 | 350.00 | 350.00 |
| 4 | Individual Occupational Therapy Session (Post-Stroke Rehab): Focus on upper limb rehabilitation, fine motor coordination, and sensory integration. | Oct 19, 2023 | 1 | 350.00 | 350.00 |
| 5 | Home Modification Consultation: Site visit to client residence in Bat Yam to assess accessibility and recommend ergonomic adaptations for independent living. | Oct 22, 2023 | 1 | 500.00 | 500.00 |
Terms and Conditions & Payment Information
1. Payment Methods: Payment is due within 30 days of the invoice date. We accept bank transfers, credit cards (Visa, MasterCard), and checks payable to "Jerusalem Rehab & Wellness Center."
2. Bank Transfer Details:
Bank: Bank Hapoalim
Branch: Jerusalem Central
Account Name: Jerusalem Rehab & Wellness Center Ltd.
Account Number: 99999-123456-7
Swift Code: POALILIT
3. Insurance Claims: This invoice is formatted to meet the requirements of major Israeli health funds (Kupat Holim), including Maccabi, Clalit, Meuhedet, and Leumit. Please submit this document along with the clinical summary provided separately to your insurance provider for reimbursement processing.
4. Service Description: All services listed were provided by a licensed Occupational Therapist registered with the Israeli Ministry of Health. The therapy sessions focus on restoring functional independence, adapting environments, and improving quality of life for patients recovering from neurological or orthopedic conditions.
5. Late Payments: A late fee of 1.5% per month will be applied to overdue balances in accordance with Israeli law regarding late payment of invoices.
6. Contact: For any questions regarding this invoice or your treatment plan, please contact our billing department in Jerusalem at +972-2-555-0199 or via email.
Authorized Signature
Sarah Cohen, M.Sc., OTR/L
Lead Occupational Therapist
Received By
Date:
⬇️ Download as DOCX Edit online as DOCXCreate your own Word template with our GoGPT AI prompt:
GoGPT