Invoice Ophthalmologist in France Marseille –Free Word Template Download with AI
Dr. Jean-Pierre Valois, Ophthalmologist
15 Avenue du Prado
13008 Marseille, France
Tel: +33 4 91 00 00 00
Email: [email protected]
SIRET: 823 456 789 00012 | TVA Intracommunautaire: FR 12 823456789
Invoice Number: INV-2023-10-045
Date of Issue: October 24, 2023
Date of Service: October 20, 2023
Due Date: November 24, 2023
Billed To (Patient)
Sophie Martin24 Rue Paradis
13001 Marseille, France
SS Number: 1 85 04 13001 123 45
Insurance: CPAM Marseille
Payor / Insurance Details
CPAM Bouches-du-RhôneService des Prestations
BP 10001
13001 Marseille Cedex 01
Convention: Secteur 1 (Agreed Fees)
| Ref | Description of Ophthalmological Services | Base Fee (€) | Quantity | Total (€) |
|---|---|---|---|---|
| 1 |
Comprehensive Ophthalmological Consultation Initial examination of the visual system including history taking, visual acuity testing, and slit-lamp biomicroscopy. This service is provided by a certified Ophthalmologist in Marseille in accordance with the French National Health Insurance fee schedule (Nomenclature des Actes). |
25.00 | 1 | 25.00 |
| 2 |
Retinal Examination with Funduscopy Detailed inspection of the retina, optic nerve, and macula to assess for diabetic retinopathy, macular degeneration, or glaucoma. Performed using direct and indirect ophthalmoscopy techniques. |
15.00 | 1 | 15.00 |
| 3 |
Tonometry (Intraocular Pressure Measurement) Measurement of eye pressure using Goldmann applanation tonometry to screen for glaucoma. Essential diagnostic procedure for patients residing in the Marseille region with family history of ocular hypertension. |
10.00 | 1 | 10.00 |
| 4 |
Refraction and Prescription Update Subjective and objective refraction to determine precise corrective lens requirements. Includes prescription for glasses or contact lenses. |
20.00 | 1 | 20.00 |
| 5 |
Ocular Ultrasound (B-Scan) Diagnostic imaging of the posterior segment of the eye. Used to evaluate retinal detachment or intraocular masses when media opacity prevents direct visualization. |
45.00 | 1 | 45.00 |
| 6 |
Prescription Medication: Artificial Tears (Hyaluronic Acid) Treatment for dry eye syndrome (Keratoconjunctivitis Sicca). Dispensed directly by the clinic pharmacy in Marseille. |
12.50 | 2 | 25.00 |
*Note: This invoice reflects the standard reimbursement rates for an Ophthalmologist in France Marseille. If you do not have supplementary insurance (Mutuelle), the Ticket Modérateur of 42.00 € is payable directly.
Important Information Regarding This Invoice
This document serves as an official Invoice for medical services rendered by Dr. Jean-Pierre Valois, a licensed Ophthalmologist practicing in Marseille, France. All procedures listed above adhere to the strict medical standards set by the French National Order of Physicians (Ordre National des Médecins).
Payment Terms: Payment is expected within 30 days of the invoice date. For patients with direct billing agreements (Tiers Payant) with their Mutuelle and CPAM, no immediate payment is required unless specified. If you are paying out-of-pocket, please note that the total base fee for these ophthalmological services is 140.00 €.
Bank Transfer Details:
Bank: Crédit Agricole Provence Côte d'Azur
IBAN: FR76 3000 4000 0100 0000 0000 000
BIC: AGRIFRPP
Reference: INV-2023-10-045
Medical Disclaimer: This invoice is for administrative and financial purposes only. It does not constitute a medical report. For detailed clinical findings, please request a separate medical certificate from the clinic. The services provided in this Marseille clinic are covered under the French social security system, but coverage may vary based on individual insurance plans.
Data Protection: In compliance with the GDPR and French data protection laws (CNIL), your personal and medical data is processed securely and solely for the purpose of billing and medical record-keeping.
Authorized Signature
Dr. Jean-Pierre ValoisOphthalmologist
Clinique Ophtalmologique de la Méditerranée ⬇️ Download as DOCX Edit online as DOCX
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