Invoice Ophthalmologist in Ghana Accra –Free Word Template Download with AI
Department of Ophthalmology
14 Independence Avenue, Ridge
Accra, Greater Accra Region
Ghana
Tel: +233 30 277 5500 | Email: [email protected]
TIN: GH-9988776655
Invoice Number: INV-2023-10-045
Date Issued: October 24, 2023
Due Date: November 07, 2023
Payment Status: Pending
Bill To:
Mr. Kwame Mensah
32 Osu Oxford Street
Osu, Accra
Ghana
Phone: +233 24 555 1234
Insurance Provider: Ecobank Health Insurance (Policy #ECB-9988)
| # | Description of Ophthalmological Services | Date of Service | Unit Price (GHS) | Total (GHS) |
|---|---|---|---|---|
| 1 |
Comprehensive Dilated Eye Examination Includes visual acuity testing, refraction, slit-lamp biomicroscopy, and funduscopy performed by a certified Ophthalmologist. |
Oct 20, 2023 | 450.00 | 450.00 |
| 2 |
Optical Coherence Tomography (OCT) High-resolution imaging of the retina and optic nerve head to assess macular health and glaucoma risk. |
Oct 20, 2023 | 600.00 | 600.00 |
| 3 |
Prescription Eyewear Dispensing Provision of anti-reflective coated lenses and titanium frame assembly as prescribed following the consultation. |
Oct 22, 2023 | 1,200.00 | 1,200.00 |
| 4 |
Glaucoma Screening & Intraocular Pressure Test Non-contact tonometry and gonioscopy to evaluate anterior chamber angle and optic nerve status. |
Oct 20, 2023 | 300.00 | 300.00 |
| 5 |
Follow-up Consultation Fee Post-procedure review of OCT results and adjustment of therapeutic regimen. |
Oct 24, 2023 | 250.00 | 250.00 |
| Subtotal: | GHS 2,800.00 |
| VAT (15%): | GHS 420.00 |
| Insurance Adjustment: | - GHS 1,500.00 |
| Total Due: | GHS 1,720.00 |
Payment Instructions & Terms
This invoice represents the professional fees charged by the Ophthalmologist at Accra Vision Specialists for the medical services rendered in Accra, Ghana. Payment is due within 14 days of the invoice date. Late payments may incur a penalty fee of 2% per month.
Bank Transfer Details:
Bank Name: Ecobank Ghana Ltd.
Account Name: Accra Vision Specialists Ltd.
Account Number: 1002345678901
Branch: Ridge Branch, Accra
Reference: INV-2023-10-045
Mobile Money (MoMo):
Provider: MTN Mobile Money
Number: 024 555 0000
Name: Accra Vision Billing
Please note that all prices are quoted in Ghana Cedis (GHS). This document serves as an official receipt for tax purposes and insurance claims within the jurisdiction of Ghana. If you have any questions regarding the charges listed on this invoice, please contact our billing department during business hours (Monday to Friday, 8:00 AM to 5:00 PM).
Thank you for choosing our Ophthalmology services. We are committed to providing the highest standard of eye care in Accra and across Ghana. Your vision is our priority.
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