Invoice Ophthalmologist in Brazil São Paulo –Free Word Template Download with AI
Specialized Ophthalmology Clinic
Av. Paulista, 1000, 15th Floor
Bela Vista, São Paulo - SP, Brazil
CEP: 01310-100
CNPJ: 12.345.678/0001-90
CRM-SP: 123456 | COREN-SP: 78901
Email: [email protected]
Phone: +55 (11) 3456-7890
Invoice Number: INV-2023-SP-0892
Date of Issue: October 24, 2023
Due Date: November 07, 2023
Service Period: October 2023
Bill To:
Mr. João Silva Santos
CPF: 123.456.789-00
Rua Augusta, 500, Apt 42
Consolação, São Paulo - SP, Brazil
CEP: 01305-000
Email: [email protected]
| # | Description of Ophthalmological Services | Tabela Brasil Code | Unit Price (BRL) | Total (BRL) |
|---|---|---|---|---|
| 1 |
Comprehensive Ophthalmological Consultation Initial evaluation including patient history, visual acuity testing, and slit-lamp examination performed by a specialist Ophthalmologist in São Paulo. |
30101.03-0 | R$ 350,00 | R$ 350,00 |
| 2 |
Dilated Fundus Examination Detailed retinal examination using mydriatic drops to assess the health of the retina, optic nerve, and macula. Essential for early detection of diabetic retinopathy and glaucoma. |
30103.05-8 | R$ 180,00 | R$ 180,00 |
| 3 |
Optical Coherence Tomography (OCT) Advanced imaging technology used to capture high-resolution cross-sectional images of the retina. This procedure is critical for diagnosing macular degeneration and other retinal pathologies. |
30105.07-4 | R$ 450,00 | R$ 450,00 |
| 4 |
Visual Field Test (Perimetry) Assessment of the peripheral vision to detect blind spots and monitor conditions such as glaucoma. Conducted using automated perimetry equipment. |
30104.01-1 | R$ 220,00 | R$ 220,00 |
| 5 |
Prescription for Corrective Lenses Detailed prescription for glasses or contact lenses based on refraction testing. Includes analysis of astigmatism and presbyopia. |
30102.01-5 | R$ 100,00 | R$ 100,00 |
| 6 |
Follow-up Consultation Subsequent visit to review test results, discuss diagnosis, and establish a treatment plan. Includes medication prescription if necessary. |
30101.04-8 | R$ 250,00 | R$ 250,00 |
| Subtotal: | R$ 1,550,00 |
| Discount (0%): | R$ 0,00 |
| ICMS (Tax - São Paulo State): | R$ 0,00 |
| Total Due: | R$ 1,550,00 |
Payment Instructions & Terms:
This Invoice is issued in accordance with Brazilian tax regulations and the professional standards of the Federal Council of Medicine (CFM) and the Regional Medical Council of São Paulo (CRM-SP). Payment is due within 14 days of the invoice date. Late payments may incur a penalty of 2% plus interest of 1% per month.
Bank Transfer (TED/DOC):
Bank: Banco do Brasil
Agency: 1234-5
Account: 98765-4
Account Holder: Vision Care São Paulo Ltda.
CNPJ: 12.345.678/0001-90
Reference: INV-2023-SP-0892
Pix Payment:
Key: [email protected]
Please include the Invoice Number as the transaction description.
Important Notes:
- This document serves as proof of payment for private health insurance reimbursement if applicable.
- All services were performed by licensed Ophthalmologists specializing in medical and surgical eye care.
- For any questions regarding this Invoice or your eye health, please contact our administrative office in São Paulo.
- Retain this document for your personal records and tax purposes.
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