Invoice Ophthalmologist in Bangladesh Dhaka –Free Word Template Download with AI
House #12, Road #5, Dhanmondi Residential Area
Dhaka-1205, Bangladesh
Phone: +880 2 9123456 | Mobile: +880 1712-345678
Email: [email protected]
VAT Registration No: 123456789012
INVOICE
Invoice No: INV-2023-10-045
Date: October 24, 2023
Due Date: October 31, 2023
Payment Status: Pending
Patient Information| Billed To: Mr. Rafiqul Islam |
Address: Flat 4B, Gulshan Avenue, Dhaka-1212, Bangladesh |
| Phone: +880 1812-987654 | Patient ID: P-88920 |
The following invoice details the professional medical services provided by our board-certified Ophthalmologist team at Dhaka Vision Care. These charges cover comprehensive eye examinations, diagnostic procedures, and surgical interventions performed within our facility in Dhaka, Bangladesh.
| # | Description of Service | Quantity | Unit Price (BDT) | Total (BDT) |
|---|---|---|---|---|
| 1 |
Comprehensive Ophthalmic Consultation Initial evaluation by Senior Ophthalmologist including medical history review and visual acuity testing. |
1 | 1,500.00 | 1,500.00 |
| 2 |
Dilated Fundus Examination Detailed retinal examination using mydriatic drops to assess the health of the retina, optic nerve, and macula. |
1 | 2,000.00 | 2,000.00 |
| 3 |
Optical Coherence Tomography (OCT) Advanced imaging scan of the retina to detect early signs of glaucoma, macular degeneration, or diabetic retinopathy. |
1 | 3,500.00 | 3,500.00 |
| 4 |
Phacoemulsification Cataract Surgery (Left Eye) Micro-incision cataract removal with implantation of a premium multifocal intraocular lens (IOL). Includes surgeon fee, anesthesia, and facility charges. |
1 | 45,000.00 | 45,000.00 |
| 5 |
Post-Operative Medication Kit Prescription antibiotics, anti-inflammatory drops, and lubricating eye drops for recovery. |
1 | 2,500.00 | 2,500.00 |
| 6 |
Follow-up Consultation Post-surgical check-up to monitor healing and intraocular pressure. |
2 | 800.00 | 1,600.00 |
Amount in words: Fifty-Eight Thousand Nine Hundred and Five Taka Only.
Payment InstructionsPlease remit payment within 7 days of the invoice date. We accept the following payment methods common in Bangladesh:
- Bank Transfer: BRAC Bank Ltd., Dhanmondi Branch. Account Name: Dhaka Vision Care Ltd. Account No: 1234567890123.
- bKash/Nagad: Corporate Number: 01712345678 (Please send transaction ID).
- Cash/Card: Accepted at the billing counter at our Dhaka clinic.
- This invoice is issued in accordance with the medical billing standards of Bangladesh.
- Payment is due within 7 days. Late payments may incur a penalty of 2% per month.
- Insurance claims must be submitted with this original invoice and the detailed medical report.
- Any disputes regarding the charges must be raised within 14 days of receiving this invoice.
- This document serves as an official receipt upon confirmation of payment.
Authorized Signature
Dr. Ayesha Rahman, MBBS, FCPS (Ophth)
Chief Ophthalmologist
Patient Acknowledgment
Signature:
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