Invoice Ophthalmologist in India New Delhi –Free Word Template Download with AI
42, Barakhamba Road, Connaught Place
New Delhi, India - 110001
Phone: +91-11-2345-6789
Email: [email protected]
GSTIN: 07AABCD1234E1Z5
Invoice Number: DVC-2024-0892
Date: October 15, 2024
Due Date: October 30, 2024
Bill To:
Mr. Rajesh Kumar Sharma
15, Green Park Extension
New Delhi, India - 110016
Phone: +91-98765-43210
Email: [email protected]
Patient Information:
Patient Name: Mr. Rajesh Kumar Sharma
Date of Birth: March 12, 1978
Age: 46 Years
Gender: Male
Medical Record Number: DVC-MR-45892
Consulting Ophthalmologist:
Dr. Priya Mehta, MS (Ophthalmology), FRCS
Senior Consultant & Vitreoretinal Surgeon
Registration No: DMCI-12345-2005
Specialization: Cataract Surgery, Retina, Cornea, and Advanced Laser Procedures
| # | Description of Ophthalmology Services | HSN Code | Qty | Unit Price (₹) | Amount (₹) |
|---|---|---|---|---|---|
| 1 | Comprehensive Ophthalmic Examination including slit-lamp biomicroscopy, fundus examination, and intraocular pressure measurement by qualified Ophthalmologist | 993312 | 1 | 1,500.00 | 1,500.00 |
| 2 | Dilated Fundus Examination with mydriatic eye drops for detailed retinal assessment | 993312 | 1 | 800.00 | 800.00 |
| 3 | Optical Coherence Tomography (OCT) Scan - Macula and Optic Nerve Head for advanced diagnostic imaging | 993312 | 1 | 2,500.00 | 2,500.00 |
| 4 | Visual Field Test (Perimetry) for glaucoma screening and neurological assessment | 993312 | 1 | 1,200.00 | 1,200.00 |
| 5 | Corneal Topography for detailed mapping of corneal surface curvature | 993312 | 1 | 1,800.00 | 1,800.00 |
| 6 | Prescription of corrective lenses and consultation for refractive error management | 993312 | 1 | 500.00 | 500.00 |
| 7 | Prescription Medications: Artificial Tears, Antibiotic Eye Drops, and Anti-inflammatory Ointment | 300490 | 1 | 950.00 | 950.00 |
| 8 | Follow-up consultation with Ophthalmologist for post-examination review and treatment planning | 993312 | 1 | 1,000.00 | 1,000.00 |
Amount in Words: Indian Rupees Twelve Thousand Ninety-Five Only
Payment Terms & Important Notes:
- This invoice is issued by Delhi Vision Care Institute, a registered ophthalmology clinic located in New Delhi, India, for professional eye care services rendered by a qualified Ophthalmologist.
- Payment is due within 15 days from the date of invoice. Late payments may attract interest at 1.5% per month.
- Accepted payment methods: Cash, UPI, Net Banking, Credit/Debit Cards, and Demand Draft payable in New Delhi.
- Bank Details for Online Transfer:
Bank Name: State Bank of India
Branch: Connaught Place, New Delhi
Account Name: Delhi Vision Care Institute Pvt. Ltd.
Account Number: 30587612345678
IFSC Code: SBIN0001234
UPI ID: delhivisioncare@upi - All ophthalmology services are performed in accordance with the standards set by the National Medical Commission (NMC) and the All India Ophthalmological Society (AIOS).
- This invoice serves as a valid medical document for insurance claims and tax purposes under Indian regulations.
- Please retain this invoice for your records. For any queries regarding billing or medical services, contact our accounts department.
- Services provided are subject to the terms and conditions of Delhi Vision Care Institute, New Delhi, India.
Authorized Signatory
For Delhi Vision Care Institute
Dr. Priya Mehta
Consulting Ophthalmologist
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