Invoice Ophthalmologist in Iraq Baghdad –Free Word Template Download with AI
Specialized Eye Care & Vision Services
Street 14, Al-Mansour District
Baghdad, Iraq
Tel: +964 770 123 4567
Email: [email protected]
VAT Registration No: IQ-2024-OPH-8842
| Invoice Number: | INV-2024-0892 |
| Date Issued: | October 15, 2024 |
| Due Date: | October 30, 2024 |
| Payment Status: | Pending |
Billed To:
Mr. Ahmed Hassan Al-Farsi
Residential Address: Block 5, House 22, Al-Karrada District
Baghdad, Iraq
Phone: +964 780 987 6543
National ID: 12345678901234
Insurance Provider: Takaful Al-Hikma Medical Insurance
Policy Number: TH-2024-556789
| # | Description of Ophthalmological Services | Quantity | Unit Price (IQD) | Total Amount (IQD) |
|---|---|---|---|---|
| 1 |
Comprehensive Ophthalmological Examination Complete eye health assessment including visual acuity testing, intraocular pressure measurement, slit-lamp examination, and dilated fundus examination performed by a certified Ophthalmologist in Baghdad. |
1 | 75,000 | 75,000 |
| 2 |
Optical Coherence Tomography (OCT) Scan Advanced retinal imaging procedure to detect and monitor macular degeneration, glaucoma, and diabetic retinopathy. Performed using state-of-the-art equipment at our Iraq Baghdad facility. |
1 | 120,000 | 120,000 |
| 3 |
Prescription Eyeglasses - Anti-Reflective Coating Custom-made prescription lenses with anti-reflective coating and UV protection. Frame selection included. Dispensed by our licensed optometrists. |
1 | 250,000 | 250,000 |
| 4 |
Glaucoma Screening & Management Consultation |
1 | 95,000 | 95,000 |
| 5 |
Prescription Medications Lubricating eye drops (Artificial Tears) - 2 bottles Antibiotic eye ointment - 1 tube Anti-inflammatory eye drops - 1 bottle All medications sourced from licensed Iraqi pharmaceutical suppliers. |
1 | 85,000 | 85,000 |
| 6 |
Follow-up Ophthalmology Appointment Scheduled follow-up visit with the treating Ophthalmologist to monitor treatment progress and adjust medication as necessary. Includes basic vision testing. |
1 | 55,000 | 55,000 |
| 7 |
Medical Report & Documentation Detailed ophthalmological medical report including diagnosis, treatment recommendations, and prognosis. Suitable for insurance claims and employer documentation in Iraq. |
1 | 30,000 | 30,000 |
| Subtotal: | 710,000 IQD |
| Discount (Insurance Coverage): | -200,000 IQD |
| Value Added Tax (VAT) 3%: | 15,300 IQD |
| Grand Total: | 525,300 IQD |
| Amount in words: Five Hundred Twenty-Five Thousand Three Hundred Iraqi Dinars | |
Payment Instructions
Currency: All amounts are quoted in Iraqi Dinar (IQD).
Payment Methods Accepted:
• Cash payment at our Baghdad clinic reception
• Bank transfer to: Al-Rafidain Bank, Account No: 1234567890123456
• Credit/Debit card (Visa, MasterCard) - 2% processing fee applies
• Mobile payment via Zain Cash or AsiaHawala
Payment Deadline: Payment is due within 15 days from the invoice date. Late payments may incur a 2% monthly interest charge as per Iraqi commercial regulations.
Insurance Claims: Please submit this invoice along with the medical report to your insurance provider. Our billing department is available to assist with insurance verification and claims processing for patients in Iraq Baghdad and surrounding areas.
Terms and Conditions
1. This invoice represents services rendered by licensed Ophthalmologists and medical staff at Al-Noor Ophthalmology Center, Baghdad, Iraq.
2. All medical services are provided in accordance with the standards set by the Iraqi Ministry of Health and the Iraqi Ophthalmology Society.
3. Prices are subject to change without prior notice. The prices listed on this invoice are valid only for the services rendered on the date specified.
4. In case of any discrepancies or questions regarding this invoice, please contact our billing department within 7 days of receipt.
5. This document serves as an official receipt upon payment confirmation and can be used for tax and insurance purposes in Iraq.
6. Patient confidentiality is maintained in accordance with Iraqi medical privacy laws. This invoice contains sensitive medical and financial information.
7. Our Ophthalmology team is committed to providing the highest quality eye care services in Baghdad. We welcome your feedback to continuously improve our patient care standards.
Authorized Signature
Dr. Layla Mohammed Al-Saffar
Chief Ophthalmologist
Al-Noor Ophthalmology Center
Patient Acknowledgment
Signature: ___________________
Date: ___________________
Printed Name: ___________________
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