Invoice Occupational Therapist in Tanzania Dar es Salaam –Free Word Template Download with AI
Address: Samora Avenue, Mikocheni, Dar es Salaam, Tanzania
Phone: +255 22 211 3456 | Mobile: +255 754 123 456
Email: [email protected]
TIN: 123-456-789-00-000
License No: MOH-DAR-OT-2023-001
Invoice #: INV-2023-10-045
Date: October 25, 2023
Due Date: November 25, 2023
Status: Unpaid
Bill To:
Client Name: Ms. Amina Juma
Organization: Kilimanjaro Insurance Company Ltd.
Address: P.O. Box 7890, Posta, Dar es Salaam, Tanzania
Contact: +255 712 345 678
Email: [email protected]
Policy Number: KIC-2023-8845
Service Location:
Facility: East African Rehabilitation Center
Address: Samora Avenue, Mikocheni, Dar es Salaam, Tanzania
Occupational Therapist: Mr. Joseph Mwakalinga, BSc OT, MSc Rehab
Registration: Tanzania Occupational Therapists Association (TOTA) Reg. #OT-2018-045
Professional Occupational Therapy Services Rendered
This Invoice represents the professional fees for comprehensive Occupational Therapy services provided to the above-named client at our facility in Dar es Salaam, Tanzania. The services were delivered by a licensed Occupational Therapist in accordance with the standards set by the Medical and Dental Practitioners Council of Tanzania and the Tanzania Occupational Therapists Association. The therapy focused on functional rehabilitation, adaptive strategies, and environmental modifications to enhance the client's independence in daily living activities.
| # | Description of Occupational Therapy Services | Date(s) | Qty | Unit Price (TZS) | Amount (TZS) |
|---|---|---|---|---|---|
| 1 |
Initial Comprehensive Occupational Therapy Assessment Detailed evaluation of client's physical, cognitive, and psychosocial functioning. Includes standardized assessments, home environment analysis, and development of individualized treatment plan. Conducted by senior Occupational Therapist at our Dar es Salaam clinic. |
Oct 02, 2023 | 1 | 150,000 | 150,000 |
| 2 |
Individual Occupational Therapy Sessions (Neurological Rehabilitation) One-on-one therapy sessions focusing on motor skill retraining, activities of daily living (ADL) training, and cognitive rehabilitation. Each session is 60 minutes, delivered by a qualified Occupational Therapist. |
Oct 05-20, 2023 | 8 | 120,000 | 960,000 |
| 3 |
Ergonomic Assessment and Workplace Modification Consultation On-site assessment of client's home and work environment in Dar es Salaam. Recommendations for adaptive equipment, furniture adjustments, and safety modifications to support independent functioning. |
Oct 12, 2023 | 1 | 200,000 | 200,000 |
| 4 |
Adaptive Equipment Prescription and Training Provision of training on use of prescribed adaptive devices including dressing aids, reachers, and modified utensils. Includes follow-up session to ensure proper utilization. |
Oct 15, 2023 | 1 | 80,000 | 80,000 |
| 5 |
Group Occupational Therapy Session (Community Reintegration) Participation in structured group therapy focusing on social skills, community participation, and vocational readiness. Facilitated by licensed Occupational Therapist. |
Oct 18, 2023 | 1 | 60,000 | 60,000 |
| 6 |
Progress Report and Insurance Documentation Comprehensive clinical report detailing treatment progress, outcomes, and recommendations for continued care. Prepared for insurance claims processing in accordance with Tanzanian healthcare regulations. |
Oct 22, 2023 | 1 | 50,000 | 50,000 |
| 7 |
Home Visit Occupational Therapy Consultation Specialized home visit to assess client's living environment in Dar es Salaam and provide hands-on training for caregivers. Includes safety assessment and environmental modification recommendations. |
Oct 24, 2023 | 1 | 180,000 | 180,000 |
| Subtotal: | TZS 1,680,000 |
| VAT (18%): | TZS 302,400 |
| Discount (Insurance Agreement): | - TZS 84,000 |
| TOTAL DUE: | TZS 1,898,400 |
Payment Instructions
Please remit payment within 30 days of the Invoice date. Payment can be made via the following methods:
Bank Transfer:
Bank: CRDB Bank Tanzania Ltd.
Branch: Mikocheni, Dar es Salaam
Account Name: East African Rehabilitation & Occupational Therapy Center
Account Number: 0123456789012
SWIFT Code: CRDBTZDX
Mobile Money: M-Pesa / Tigo Pesa / Airtel Money: +255 754 123 456
Cheque: Payable to "East African Rehabilitation & Occupational Therapy Center"
Please reference Invoice Number INV-2023-10-045 with all payments.
Terms and Conditions
1. This Invoice is issued in accordance with the Tax Administration Act of Tanzania and all applicable healthcare regulations.
2. All Occupational Therapy services were provided by licensed professionals registered with the Tanzania Occupational Therapists Association and the Medical and Dental Practitioners Council of Tanzania.
3. Payment is due within 30 days. Late payments may incur a penalty of 2% per month on the outstanding balance.
4. This Invoice covers professional fees only. Costs for adaptive equipment, medications, or third-party services are billed separately.
5. In case of disputes, please contact our billing department within 14 days of receiving this Invoice.
6. All services were rendered at our facility in Dar es Salaam, Tanzania, unless otherwise specified.
7. This document serves as an official receipt upon payment confirmation.
Authorized by:
Dr. Sarah Mushi
Chief Occupational Therapist
East African Rehabilitation Center
Date: October 25, 2023
Received by:
_________________________
Name:
Date:
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