Invoice Ophthalmologist in Egypt Alexandria –Free Word Template Download with AI
Specialized Ophthalmology Clinic
123 El-Horreya Avenue, Sporting District
Alexandria, Egypt 21500
Tel: +20 3 546 7890 | Email: [email protected]
Tax ID: 123-456-789000
Invoice Number: INV-2023-10-045
Date of Issue: October 24, 2023
Due Date: November 07, 2023
Service Location: Alexandria, Egypt
Bill To:
Patient Name: Ahmed Hassan Mohamed
Address: 45 Saad Zaghloul Street, Smouha
Alexandria, Egypt
Phone: +20 10 1234 5678
National ID: 29001012345678
Insurance / Third Party:
Provider: Bupa Egypt
Policy Number: BUPA-EG-998877
Group ID: CORP-ALX-001
Authorization Ref: AUTH-2023-554
| # | Description of Ophthalmological Services | Date | Unit Price (EGP) | Total (EGP) |
|---|---|---|---|---|
| 1 |
Comprehensive Ophthalmic Examination Includes visual acuity testing, refraction, slit-lamp biomicroscopy, and tonometry. Performed by a certified Ophthalmologist in Alexandria. |
Oct 24, 2023 | 800.00 | 800.00 |
| 2 |
Dilated Fundus Examination Detailed inspection of the retina, optic nerve, and macula using mydriatic agents. Essential for diagnosing diabetic retinopathy and glaucoma. |
Oct 24, 2023 | 600.00 | 600.00 |
| 3 |
Optical Coherence Tomography (OCT) High-resolution cross-sectional imaging of the retina to assess macular thickness and nerve fiber layer integrity. |
Oct 24, 2023 | 1,200.00 | 1,200.00 |
| 4 |
Corneal Topography Mapping of the anterior corneal surface curvature. Required for contact lens fitting and pre-operative assessment for refractive surgery. |
Oct 24, 2023 | 900.00 | 900.00 |
| 5 |
Prescription Eyewear Consultation Finalization of prescription and consultation regarding lens materials and coatings suitable for the patient's lifestyle in Alexandria. |
Oct 24, 2023 | 300.00 | 300.00 |
| 6 |
Pharmacological Supplies Mydriatic eye drops (Tropicamide) and lubricating eye drops prescribed post-examination. |
Oct 24, 2023 | 250.00 | 250.00 |
Terms and Conditions & Important Notes:
1. Currency: All amounts are quoted in Egyptian Pounds (EGP).
2. Payment Terms: Payment is due within 14 days of the invoice date. Late payments may incur a penalty fee as per Egyptian commercial law.
3. Insurance Claims: This invoice is issued for the purpose of insurance reimbursement. Please submit this document along with the medical report to your insurance provider.
4. Validity: This invoice is valid for 30 days from the date of issue.
5. Disputes: Any discrepancies regarding the services provided by our Ophthalmologist must be reported within 7 days of receipt.
6. Jurisdiction: This transaction is subject to the laws of Egypt, specifically within the jurisdiction of Alexandria courts.
7. Follow-up: Please schedule your follow-up appointment as advised by the attending Ophthalmologist to ensure optimal eye health.
Authorized Signature:
Dr. Sarah El-SayedChief Ophthalmologist
Alexandria Vision & Eye Care Center ⬇️ Download as DOCX Edit online as DOCX
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