Invoice Ophthalmologist in China Beijing –Free Word Template Download with AI
No. 88 Chaoyangmen North Street, Chaoyang District
Beijing, 100020, People's Republic of China
Tel: +86 10 8512 3456 | Email: [email protected]
Unified Social Credit Code: 91110105MA01XXXXXJ
Official Medical Receipt
Bill To (Patient Information)
Name: Mr. Zhang Wei
ID Number: 11010519850101XXXX
Address: Apt 402, Building 5, Haidian District, Beijing, China
Phone: +86 138 0000 1234
Insurance Provider: Beijing Basic Medical Insurance
| Item | Description of Ophthalmological Services | Code | Quantity | Amount (CNY) |
|---|---|---|---|---|
| 1 |
Comprehensive Ophthalmological Examination Includes visual acuity testing, refraction, and slit-lamp biomicroscopy performed by a certified Ophthalmologist in Beijing. |
OPH-001 | 1 | ¥ 350.00 |
| 2 |
Optical Coherence Tomography (OCT) High-resolution retinal imaging to assess macular health and optic nerve structure. |
OPH-005 | 1 | ¥ 420.00 |
| 3 |
Intraocular Pressure Measurement (Tonometry) Goldmann applanation tonometry to screen for glaucoma. |
OPH-012 | 1 | ¥ 80.00 |
| 4 |
Specialist Consultation Fee Consultation with Senior Ophthalmologist Dr. Li Na regarding diagnosis and treatment plan. |
OPH-900 | 1 | ¥ 200.00 |
| 5 |
Prescription Medication Artificial Tears (Hyaluronic Acid 0.1%) - 2 Bottles. |
PHM-204 | 2 | ¥ 120.00 |
| 6 |
Prescription Medication Antibiotic Eye Drops (Levofloxacin 0.5%) - 1 Bottle. |
PHM-209 | 1 | ¥ 45.00 |
Payment Instructions & Terms
This Invoice serves as the official financial record for the ophthalmological services rendered at our clinic in China Beijing. Payment is expected immediately upon the conclusion of the appointment. We accept UnionPay cards, Alipay, WeChat Pay, and cash (CNY).
Bank Transfer Details (For Corporate Billing):
Bank Name: Bank of China, Beijing Chaoyang Branch
Account Name: Beijing Vision Care Ophthalmology Center Co., Ltd.
Account Number: 3589 2010 0000 1234 567
SWIFT Code: BKCHCNBJ800
Important Notice: Please retain this Invoice for your personal records and for submission to your insurance provider for reimbursement if applicable. According to the regulations of the National Healthcare Security Administration of China, this document is valid for tax deduction purposes. Any discrepancies regarding the charges for the Ophthalmologist's services must be reported within 30 days of the date of issue.
Thank you for choosing Beijing Vision Care Ophthalmology Center for your eye health needs. We are committed to providing world-class ophthalmic care in the heart of Beijing.
Authorized SignatureDr. Li Na
Senior Ophthalmologist
Beijing Vision Care Ophthalmology Center Financial Officer Signature
Ms. Wang Fang
Head of Billing Department
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