Invoice Ophthalmologist in China Shanghai –Free Word Template Download with AI
Specialized Ophthalmology & Optometry Center
Room 1205, Pudong Medical Plaza, Century Avenue
Pudong New Area, Shanghai, China 200120
Tel: +86 21 5888 9999 | Email: [email protected]
Unified Social Credit Code: 91310115MA1K3XXXXX
Invoice Number: INV-SH-2023-10-045
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Service Provider (Ophthalmologist)
Dr. Li Wei, MD, PhD
Chief Ophthalmologist & Retina Specialist
Licensed by the Shanghai Municipal Health Commission
License No: SH-Oph-2015-8892
Bill To
Mr. Zhang Jian
1888 Huaihai Middle Road, Xuhui District
Shanghai, China 200031
ID Number: 31010419850101XXXX
Contact: +86 138 0000 1234
| # | Description of Ophthalmological Services | Quantity | Unit Price (CNY) | Total (CNY) |
|---|---|---|---|---|
| 1 |
Comprehensive Ophthalmic Consultation Initial assessment by senior ophthalmologist in Shanghai Vision Excellence Clinic. Includes medical history review, symptom analysis, and preliminary diagnosis. |
1 | 500.00 | 500.00 |
| 2 |
Dilated Fundus Examination Detailed examination of the retina, optic nerve, and macula using advanced imaging technology. Essential for detecting diabetic retinopathy and glaucoma. |
1 | 350.00 | 350.00 |
| 3 |
Optical Coherence Tomography (OCT) High-resolution cross-sectional imaging of the retina to assess macular thickness and detect fluid accumulation or structural abnormalities. |
1 | 600.00 | 600.00 |
| 4 |
Visual Field Test (Perimetry) Assessment of peripheral vision to diagnose and monitor glaucoma, neurological disorders, and other visual field defects. |
1 | 400.00 | 400.00 |
| 5 |
Corneal Topography Mapping of the corneal surface curvature to evaluate astigmatism, keratoconus, and suitability for refractive surgery. |
1 | 450.00 | 450.00 |
| 6 |
Prescription Eyewear Dispensing Supply of high-index anti-reflective lenses and premium titanium frame as prescribed by the ophthalmologist. |
1 | 1,200.00 | 1,200.00 |
| 7 |
Pharmacological Treatment Prescription of lubricating eye drops and anti-inflammatory medication for post-examination care. |
2 | 150.00 | 300.00 |
Payment Terms and Conditions
This invoice represents the professional fees for ophthalmological services rendered by Dr. Li Wei at the Shanghai Vision Excellence Clinic. Payment is due within 30 days of the invoice date. Please reference the Invoice Number (INV-SH-2023-10-045) on all payments.
Bank Transfer Details:
Bank Name: Bank of China, Pudong Branch
Account Name: Shanghai Vision Excellence Clinic Co., Ltd.
Account Number: 4567 8901 2345 6789
SWIFT Code: BKCHCNBJ300
Legal Notice:
This document serves as a formal financial record compliant with the tax regulations of the People's Republic of China. The services provided adhere to the highest standards of ophthalmic care recognized in Shanghai and internationally. Any disputes regarding this invoice should be directed to the billing department within 14 days.
Medical Disclaimer:
The charges listed above are for administrative and financial purposes only. They do not constitute medical advice. Please follow the treatment plan prescribed by your ophthalmologist strictly. Regular follow-ups are recommended to ensure optimal eye health.
Create your own Word template with our GoGPT AI prompt:
GoGPT