Invoice Ophthalmologist in France Paris –Free Word Template Download with AI
12 Avenue de l'Opéra, 75001 Paris, France
Tel: +33 1 42 60 00 00 | Email: [email protected]
SIRET: 852 963 741 00012 | TVA Intracommunautaire: FR 12 852963741
Ordre des Médecins de Paris: 123456789
INVOICE
Bill To (Patient)
Mr. Jean-Pierre Dubois
45 Rue de Rivoli
75004 Paris, France
SS Number (Sécurité Sociale): 1 75 10 750 123 456 78
Complementary Insurance: Mutuelle Santé Plus
Attestation of Care
This document serves as an official invoice for medical services rendered by a licensed Ophthalmologist in France Paris. It is intended for reimbursement purposes by the French National Health Insurance (Assurance Maladie) and your complementary private insurance provider.
Consultation Type: Specialized Ophthalmology
| Ref | Description of Ophthalmological Services | Code (Nomenclature) | Rate (€) | Quantity | Total (€) |
|---|---|---|---|---|---|
| 1 |
Comprehensive Ophthalmological Consultation Detailed examination of visual acuity, intraocular pressure measurement (tonometry), and slit-lamp biomicroscopy. This consultation addresses the patient's reported symptoms of dry eye syndrome and presbyopia. |
Q401 | 25.00 | 1 | 25.00 |
| 2 |
Dilated Fundus Examination Pharmacological mydriasis followed by indirect ophthalmoscopy to assess the retina, optic nerve, and macula. Essential for ruling out glaucoma and diabetic retinopathy in a high-risk patient profile. |
Q402 | 15.00 | 1 | 15.00 |
| 3 |
Optical Prescription Analysis Refraction test to determine precise corrective lens requirements. Includes analysis of astigmatism and binocular vision assessment. |
Q403 | 10.00 | 1 | 10.00 |
| 4 |
Therapeutic Intervention Application of specialized lubricating eye drops and prescription of anti-inflammatory medication for acute conjunctival irritation. |
Q404 | 20.00 | 1 | 20.00 |
| 5 |
Administrative Fees Processing fee for generating the official invoice and medical certificate required for insurance claims in France Paris. |
ADM-01 | 5.00 | 1 | 5.00 |
Important Information Regarding Payment and Insurance
This invoice reflects the standard fees charged by our Ophthalmologist practice located in France Paris. Please note that medical services provided by physicians in France are generally exempt from Value Added Tax (VAT/TVA) under Article 261 of the French General Tax Code.
Reimbursement Process: The amount listed as "Amount Paid by Assurance Maladie" represents the standard reimbursement rate calculated by the French Social Security system based on the official fee schedule (Tarif de Convention). The remaining balance is the patient's responsibility, which may be partially or fully covered by your complementary health insurance (Mutuelle). Please submit this invoice along with your Carte Vitale transaction receipt to your insurance provider for further reimbursement.
Payment Methods: We accept bank transfers, credit cards (Visa, Mastercard), and cash. For bank transfers, please reference the Invoice Number INV-2023-10-892.
Bank Details:
Bank: BNP Paribas, Paris Opéra
IBAN: FR76 3000 4000 0100 0000 0000 000
BIC: BNPAFRPP
Legal Notice: In accordance with French commercial law, late payments may incur statutory interest. This document constitutes a legal record of the medical transaction between the Ophthalmologist and the patient. Retain this invoice for your personal records for a minimum of 10 years.
Authorized Signature of the Ophthalmologist
Dr. Antoine MoreauChief Ophthalmologist
Clinique Ophtalmologique de la Seine ⬇️ Download as DOCX Edit online as DOCX
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