Invoice Ophthalmologist in China Guangzhou –Free Word Template Download with AI
No. 188 Tianhe Road, Tianhe District
Guangzhou, Guangdong Province, China 510000
Tel: +86 20 8888 9999 | Email: [email protected]
Unified Social Credit Code: 91440106MA5CU8XXXX
Official Medical Billing Document
Billed To:Mr. David Chen
Room 2405, Tower B, IFC Mall
Zhujiang New Town, Tianhe District
Guangzhou, Guangdong, China 510623
Phone: +86 138 0000 1234
Email: [email protected]
| # | Description of Ophthalmological Services | Qty | Unit Price (CNY) | Total (CNY) |
|---|---|---|---|---|
| 1 | Comprehensive Ophthalmological Examination including slit-lamp biomicroscopy, funduscopy, and intraocular pressure measurement performed by senior Ophthalmologist. | 1 | 350.00 | 350.00 |
| 2 | Advanced Optical Coherence Tomography (OCT) of the retina and optic nerve head for detailed structural analysis. | 1 | 480.00 | 480.00 |
| 3 | Corneal Topography Mapping to assess surface curvature and detect irregular astigmatism or keratoconus. | 1 | 320.00 | 320.00 |
| 4 | Specialist Consultation Fee: Detailed diagnosis and treatment plan formulation by Board-Certified Ophthalmologist in Guangzhou. | 1 | 200.00 | 200.00 |
| 5 | Prescription Medication: Artificial Tears (Hyaluronic Acid 0.1%) - 3 bottles for dry eye syndrome management. | 3 | 45.00 | 135.00 |
| 6 | Prescription Medication: Antibiotic Eye Drops (Levofloxacin 0.5%) - 2 bottles for post-examination prophylaxis. | 2 | 38.00 | 76.00 |
| 7 | Visual Field Test (Perimetry) to evaluate peripheral vision and detect glaucomatous defects. | 1 | 250.00 | 250.00 |
| 8 | Follow-up Appointment Scheduling and Digital Health Record Management within the Guangzhou municipal healthcare system. | 1 | 50.00 | 50.00 |
| Subtotal: | 1,861.00 CNY |
| Medical Insurance Deductible (if applicable): | -200.00 CNY |
| Net Amount: | 1,661.00 CNY |
| VAT (6%): | 99.66 CNY |
| Grand Total Due: | 1,760.66 CNY |
Payment Instructions & Important Notes
This Invoice serves as an official financial record for ophthalmological services rendered at our Guangzhou facility. Payment is due within 15 days of the invoice date. Please include the Invoice Number (GZ-OPTH-2024-0892) as a reference for all transactions.
Bank Transfer Details:
Bank Name: Industrial and Commercial Bank of China (ICBC), Guangzhou Tianhe Branch
Account Name: Guangzhou Vision Care Ophthalmology Center Co., Ltd.
Account Number: 4000 1234 5678 9012 345
SWIFT Code: ICBKCNBJGZG
Insurance Claims:
For international patients or those using private health insurance, this document can be submitted directly to your provider. Our billing department in Guangzhou is available to assist with pre-authorization requests or additional documentation required by your insurer. Please note that certain advanced diagnostic procedures performed by our specialist Ophthalmologist may require prior approval.
Medical Disclaimer:
This invoice reflects the costs associated with the diagnostic and therapeutic services provided. It does not constitute a guarantee of medical outcomes. All treatments were administered in accordance with the professional standards of ophthalmology practiced in China and internationally. Patients are advised to follow the prescribed treatment plan and attend scheduled follow-up appointments to ensure optimal visual health.
Contact Information:
For any questions regarding this invoice or your ophthalmological care, please contact our billing office at +86 20 8888 9999 or email [email protected]. Our office is located in the heart of Guangzhou’s Tianhe District, easily accessible via Metro Line 1 or Line 3 at Tianhe Sports Center Station.
Dr. Li Wei
Chief Ophthalmologist
Guangzhou Vision Care Ophthalmology Center Received by:
_________________________
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