Invoice Occupational Therapist in Sri Lanka Colombo –Free Word Template Download with AI
Specialized Occupational Therapy Clinic
No. 45, Galle Road, Colombo 03, Sri Lanka
Tel: +94 11 234 5678 | Email: [email protected]
Reg No: SL-OT-2023-8899 | VAT No: 123456789V
Invoice Number: INV-2023-10-045
Date of Issue: October 24, 2023
Due Date: November 07, 2023
Bill To:
Mr. Anura Perera
12/4, Lake House Road
Colombo 07, Sri Lanka
NIC: 198567891234
Email: [email protected]
Service Period:
Start Date: October 01, 2023
End Date: October 23, 2023
Location: Colombo Integrated Rehabilitation Services, Colombo 03
This Invoice serves as a formal request for payment for professional healthcare services rendered by our licensed Occupational Therapist team. The services detailed below were provided in accordance with the clinical treatment plan established for the patient at our facility in Sri Lanka Colombo. Our clinic adheres to the highest standards of medical practice and regulatory compliance set by the Sri Lankan Ministry of Health.
The primary objective of these sessions was to enhance the patient's functional independence through evidence-based occupational therapy interventions. The Occupational Therapist conducted comprehensive assessments, including ADL (Activities of Daily Living) evaluations, cognitive screening, and fine motor skill analysis. The treatment plan focused on neuro-rehabilitation techniques, ergonomic adaptations for the home environment in Colombo, and therapeutic exercises designed to improve upper limb dexterity and coordination.
| # | Description of Services | Quantity / Hours | Unit Price (LKR) | Total (LKR) |
|---|---|---|---|---|
| 1 |
Initial Comprehensive Assessment Conducted by Senior Occupational Therapist. Includes history taking, physical examination, and functional capacity evaluation. |
1 | 8,500.00 | 8,500.00 |
| 2 |
Individual Therapy Sessions (Neuro-Rehab) One-on-one sessions focusing on motor control, sensory integration, and cognitive rehabilitation. 45 minutes per session. |
8 | 5,000.00 | 40,000.00 |
| 3 |
ADL Training & Home Modification Consultation Training in daily living skills and assessment of home environment in Colombo for accessibility improvements. |
2 | 6,000.00 | 12,000.00 |
| 4 |
Therapeutic Equipment Rental Monthly rental of adaptive utensils and splinting devices provided during the therapy period. |
1 | 3,500.00 | 3,500.00 |
| 5 |
Clinical Report & Progress Documentation Detailed written report by the Occupational Therapist for insurance or medical records. |
1 | 2,500.00 | 2,500.00 |
| Subtotal: | 66,500.00 LKR |
| VAT (8%): | 5,320.00 LKR |
| Discount (Early Bird): | -1,000.00 LKR |
| Total Amount Due: | 70,820.00 LKR |
Payment Instructions
Please remit payment within 14 days of the invoice date. Payments can be made via:
- Bank Transfer: Commercial Bank of Ceylon, Colombo Branch. Account Name: Colombo Integrated Rehabilitation Services. Account No: 1234-5678-9012.
- Cash: Accepted at our reception desk in Colombo 03.
- Credit Card: Visa/Mastercard accepted via our secure online portal.
Terms and Conditions
- This Invoice is valid for payment within 30 days. Late payments may incur a penalty fee of 1.5% per month.
- All services provided by our Occupational Therapist are subject to the availability of the specialist and the clinical needs of the patient.
- Prices are quoted in Sri Lankan Rupees (LKR) and are inclusive of applicable taxes unless stated otherwise.
- Our clinic in Sri Lanka Colombo reserves the right to modify treatment plans based on medical progress, which may affect future billing.
- Insurance claims should be submitted directly by the patient using this invoice and the attached clinical report.
- For any discrepancies regarding this invoice, please contact our billing department within 7 days.
We thank you for trusting Colombo Integrated Rehabilitation Services with your healthcare needs. Our dedicated team of Occupational Therapists is committed to helping you regain independence and improve your quality of life.
Authorized By:
Dr. Malini FernandoLead Occupational Therapist
License No: OT-SL-4455
Received By:
(Client Signature)Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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