Invoice Ophthalmologist in DR Congo Kinshasa –Free Word Template Download with AI
Avenue de la Paix, Gombe
Kinshasa, Democratic Republic of the Congo
Phone: +243 81 000 0000
Email: [email protected]
Invoice Number: INV-KIN-2023-0892
Date of Issue: October 24, 2023
Due Date: November 07, 2023
Service Provider (Ophthalmologist)
Dr. Jean-Pierre Mbemba, MD, PhD
Board-Certified Ophthalmologist
License No: RDC-MED-OPH-4492
Member of the Congolese Society of Ophthalmology
Tax Identification Number (NIF): 001234567890123
Billed To
Monsieur Antoine Kambale
123 Avenue du 30 Juin
Matonge, Kinshasa
Democratic Republic of the Congo
Phone: +243 99 123 4567
Insurance Provider: Mutuelle Santé Congo
Policy Number: MSC-998877
Statement of Services Rendered
This document serves as the official financial record for the comprehensive ophthalmological care provided to the patient listed above. The services were conducted at our facility in Kinshasa, adhering to the highest standards of medical practice recognized within the Democratic Republic of the Congo and internationally. The following items detail the diagnostic procedures, surgical interventions, and pharmaceutical supplies provided by our team of specialized ophthalmologists.
| Item | Description of Ophthalmological Service | Date | Quantity | Unit Price (CDF) | Total (CDF) |
|---|---|---|---|---|---|
| 1 | Comprehensive Ophthalmic Examination: Initial consultation including visual acuity testing, refraction, slit-lamp biomicroscopy, and tonometry to assess intraocular pressure. Conducted by Dr. Mbemba. | Oct 20, 2023 | 1 | 150,000 | 150,000 |
| 2 | Dilated Fundus Examination: Administration of mydriatic drops and detailed retinal examination to screen for diabetic retinopathy and macular degeneration, critical for patients in the Kinshasa region. | Oct 20, 2023 | 1 | 80,000 | 80,000 |
| 3 | Phacoemulsification with IOL Implantation: Advanced cataract surgery performed on the right eye. Includes pre-operative anesthesia, surgical fees, and post-operative monitoring. Utilizing premium intraocular lens technology. | Oct 22, 2023 | 1 | 2,500,000 | 2,500,000 |
| 4 | Post-Operative Medication Kit: Prescription antibiotics (Moxifloxacin eye drops), anti-inflammatory steroids (Prednisolone acetate), and lubricating eye drops for the recovery period in Kinshasa. | Oct 22, 2023 | 1 | 120,000 | 120,000 |
| 5 | Follow-up Consultation: Assessment of surgical site healing, suture check (if applicable), and visual acuity re-evaluation. | Oct 24, 2023 | 1 | 75,000 | 75,000 |
(Three Million, Three Hundred Ninety-Three Thousand Congolese Francs)
Important Notes & Payment Terms:
- Currency: All amounts are listed in Congolese Francs (CDF), the official currency of the Democratic Republic of the Congo.
- Payment Methods: Payments can be made via bank transfer to our account at Banque Commerciale du Congo (BCC), cash at the clinic reception in Kinshasa, or mobile money (M-Pesa/Airtel Money).
- Bank Details: Bank: BCC Kinshasa | Account Name: Clinique Ophtalmologique de la Nation | Account No: 123-456-7890 | SWIFT: BCCDCDKI
- Validity: This invoice is valid for 30 days from the date of issue. Late payments may incur a penalty fee of 2% per month.
- Medical Disclaimer: This invoice reflects the financial transaction for services rendered. It does not constitute a medical diagnosis or prognosis. Please refer to your medical report for clinical details.
- Regulatory Compliance: This document complies with the tax regulations of the Direction Générale des Impôts (DGI) of the DRC.
Authorized Signature (Ophthalmologist)
Dr. Jean-Pierre Mbemba
Patient Acknowledgement
M. Antoine Kambale
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