Invoice Ophthalmologist in Argentina Buenos Aires –Free Word Template Download with AI
Specialist Ophthalmologist
Matrícula Médica: 45.892 | Matrícula Especialidad: 12.345
Av. Santa Fe 1850, Piso 4, Of. 4B
C1425BGH CABA, Buenos Aires, Argentina
Tel: +54 11 4823-5678 | Email: [email protected]
CUIT: 20-23456789-0
Invoice Number: INV-2023-00458
Date of Issue: October 24, 2023
Due Date: November 07, 2023
Currency: Argentine Peso (ARS)
Bill To (Paciente / Aseguradora)
María Elena Fernández
DNI: 28.456.789
Av. Córdoba 2100, Depto 12C
C1054AAZ CABA, Buenos Aires, Argentina
Email: [email protected]
Insurance / Coverage Details
Prepaid Health Plan: OSDE
Policy Number: 987654321
Group Number: GRP-BA-550
Authorization Code: AUT-2023-8899
Coverage Type: Copayment (Copago)
Service Context: This invoice represents professional ophthalmological services rendered in Buenos Aires, Argentina. The procedures include comprehensive diagnostic evaluation, retinal imaging, and specialized consultation fees in accordance with the current tariff guidelines of the Colegio Médico de la Ciudad Autónoma de Buenos Aires. All services were performed at the clinic located in the Santa Fe Avenue medical district.| # | Description of Ophthalmological Service | Code | Quantity | Unit Price (ARS) | Total (ARS) |
|---|---|---|---|---|---|
| 1 |
Specialist Ophthalmology Consultation Comprehensive eye examination including patient history review, visual acuity testing (Snellen chart), slit-lamp biomicroscopy of anterior segment, and intraocular pressure measurement (Tonometry). Performed by Dr. Alejandro Rossi in Buenos Aires. |
OPH-001 | 1 | 45.000,00 | 45.000,00 |
| 2 |
Dilated Fundus Examination Pharmacological mydriasis (pupil dilation) using tropicamide and phenylephrine drops to allow detailed inspection of the retina, optic nerve head, and macula. Essential for diagnosing diabetic retinopathy and glaucoma. |
OPH-005 | 1 | 25.000,00 | 25.000,00 |
| 3 |
Optical Coherence Tomography (OCT) High-resolution cross-sectional imaging of the retina. Used to assess macular thickness and detect early signs of macular degeneration or edema. Includes digital report generation. |
OPH-012 | 1 | 60.000,00 | 60.000,00 |
| 4 |
Visual Field Test (Perimetry) Automated Humphrey visual field analysis to evaluate peripheral vision and detect blind spots associated with glaucoma or neurological conditions. |
OPH-015 | 1 | 55.000,00 | 55.000,00 |
| 5 |
Prescription and Management Plan Preparation of detailed medical prescription for corrective lenses (if applicable), therapeutic eye drops, and follow-up schedule. Includes written summary for primary care physician. |
OPH-020 | 1 | 15.000,00 | 15.000,00 |
Payment Instructions & Legal Notes
This invoice is issued in accordance with the tax regulations of the Argentine Republic (AFIP). Payment is due within 14 days of the invoice date. Please reference Invoice Number INV-2023-00458 on all payments.
Bank Transfer Details:
Bank: Banco Galicia
CBU: 0070000000000000123456
Account Holder: Dr. Alejandro Rossi
Alias: DR.ROSSI.OFTALMO.BA
Cash Payments: Accepted at the clinic in Buenos Aires (Av. Santa Fe 1850) during business hours (Monday to Friday, 9:00 AM - 6:00 PM).
Medical Disclaimer: This invoice documents financial transactions for medical services rendered. It does not constitute a medical diagnosis or treatment plan. For medical inquiries, please contact the clinic directly. All ophthalmological procedures were performed following the ethical and technical standards established by the Sociedad Argentina de Oftalmología.
Validity: This invoice is valid for tax deduction purposes in Argentina. Please retain this document for your records. If you have any questions regarding the charges or the ophthalmological services provided, please contact our administrative office in Buenos Aires.
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