Invoice Occupational Therapist in Qatar Doha –Free Word Template Download with AI
Specialized Occupational Therapy Services
Building 45, Street 322, Zone 63
Al Sadd, Doha, Qatar
P.O. Box: 23456
Tel: +974 4412 3456 | Email: [email protected]
Commercial Registration (CR): 123456789
VAT Registration Number: 100012345678
Invoice Number: INV-QA-2023-0892
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Payment Terms: Net 30 Days
Bill To:
Qatar National Insurance Company (QNI)
Attn: Claims Department
Building 12, Street 50, Al Waab
Doha, Qatar
Policy Holder: Mr. Ahmed Al-Thani
Policy Number: QNI-POL-998877
Service Provided To:
Patient Name: Mr. Ahmed Al-Thani
QID Number: 29901234567890
Diagnosis: Post-Stroke Upper Limb Rehabilitation
Treatment Location: Al-Amal Clinic, Doha
| # | Description of Occupational Therapy Services | Date | Qty | Unit Price (QAR) | Total (QAR) |
|---|---|---|---|---|---|
| 1 |
Initial Comprehensive Assessment Evaluation of motor skills, sensory processing, and activities of daily living (ADLs) conducted by a licensed Occupational Therapist in Doha. Includes cognitive screening and home safety assessment. |
Oct 01 | 1 | 450.00 | 450.00 |
| 2 |
Individual Therapy Sessions (Neurological) One-on-one sessions focusing on fine motor coordination, grasp patterns, and bimanual tasks. Tailored specifically for neurological recovery within the standards of Qatar's healthcare regulations. |
Oct 03-20 | 8 | 350.00 | 2,800.00 |
| 3 |
Assistive Technology Training Instruction on the use of adaptive equipment for dressing and feeding. Includes demonstration and practice of techniques to maximize independence in the home environment. |
Oct 10 | 2 | 300.00 | 600.00 |
| 4 |
Ergonomic Workplace Consultation Remote consultation regarding workstation setup to prevent strain and facilitate return to work. Provided by senior Occupational Therapist based in Doha. |
Oct 15 | 1 | 500.00 | 500.00 |
| 5 |
Progress Report & Care Plan Update Detailed documentation of patient progress, updated therapeutic goals, and recommendations for the next phase of treatment. Submitted to the referring physician. |
Oct 22 | 1 | 250.00 | 250.00 |
Amount in Words: Five Thousand and Sixty Qatari Riyals Only.
Important Notes & Terms of Service:
- Licensing: All Occupational Therapy services rendered in this invoice are performed by practitioners fully licensed by the Ministry of Public Health (MoPH) in Qatar.
- Payment Methods: Payments can be made via bank transfer to Doha Bank (IBAN: QA32DOHA1234567890), credit card, or cash at our Doha office.
- Insurance Claims: This invoice is formatted to meet the requirements of major insurance providers in Qatar. Please reference the Policy Number and QID provided above when processing claims.
- Late Fees: A late fee of 2% per month will be applied to outstanding balances after the due date of November 24, 2023.
- Disputes: Any discrepancies regarding the services provided must be reported within 14 days of the invoice date.
- Confidentiality: Patient information included in this document is confidential and shared solely for billing purposes in accordance with Qatar's data privacy laws.
Authorized By:
Dr. Sarah Al-Mansouri
Head of Occupational Therapy
Al-Amal Rehabilitation Center
Received By:
__________________________
Date: ____________________
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