Invoice Ophthalmologist in Israel Tel Aviv –Free Word Template Download with AI
Dr. Sarah Cohen, MD
Board-Certified Ophthalmologist
123 Rothschild Boulevard
Tel Aviv-Yafo, Israel 6688101
Phone: +972-3-555-1234
Email: [email protected]
VAT ID: 512345678
Invoice Number: INV-2024-0892
Date of Issue: October 26, 2024
Due Date: November 26, 2024
Service Location: Tel Aviv, Israel
Mr. David Levi
45 Allenby Street
Tel Aviv-Yafo, Israel 6672901
ID Number: 123456789
Insurance Provider: Maccabi Healthcare Services
Policy Number: MAC-987654321
This invoice details the professional medical services provided by Dr. Sarah Cohen, a licensed Ophthalmologist practicing in Tel Aviv, Israel. The services rendered are in accordance with the standards set by the Israeli Medical Association and the Ministry of Health. All procedures were conducted at our clinic located in the heart of Tel Aviv, utilizing state-of-the-art diagnostic equipment.
| Item # | Description of Service | Code | Quantity | Unit Price (ILS) | Total (ILS) |
|---|---|---|---|---|---|
| 1 | Comprehensive Ophthalmological Examination including visual acuity, refraction, and slit-lamp biomicroscopy. | OPH-001 | 1 | 350.00 | 350.00 |
| 2 | Dilated Fundus Examination to assess the retina, optic nerve, and macula for signs of pathology. | OPH-002 | 1 | 200.00 | 200.00 |
| 3 | Optical Coherence Tomography (OCT) of the macula and optic nerve head for detailed cross-sectional imaging. | OPH-003 | 1 | 450.00 | 450.00 |
| 4 | Non-contact Tonometry to measure intraocular pressure and screen for glaucoma. | OPH-004 | 1 | 150.00 | 150.00 |
| 5 | Corneal Topography mapping to evaluate the curvature and shape of the cornea. | OPH-005 | 1 | 300.00 | 300.00 |
| 6 | Prescription for corrective lenses (glasses) based on refraction results. | OPH-006 | 1 | 100.00 | 100.00 |
| 7 | Consultation regarding potential refractive surgery options (LASIK/PRK) and pre-operative assessment. | OPH-007 | 1 | 500.00 | 500.00 |
| Subtotal: | 2,050.00 ILS |
| VAT (17%): | 348.50 ILS |
| Total Amount Due: | 2,398.50 ILS |
Payment is due within 30 days of the invoice date. Please make payments in Israeli New Shekels (ILS).
Bank Transfer Details:
Bank: Bank Hapoalim
Branch: Tel Aviv Central
Account Name: Tel Aviv Vision Center Ltd.
Account Number: 999-888-777
Swift Code: HAPoilmm
For credit card payments, please contact our billing department at +972-3-555-1234.
Terms and Conditions
1. This invoice is issued by a licensed Ophthalmologist in Tel Aviv, Israel, and is valid for tax purposes.
2. Services are provided under the supervision of Dr. Sarah Cohen, MD.
3. Insurance claims should be submitted directly to your provider with a copy of this invoice.
4. Late payments may incur a penalty of 1.5% per month.
5. All medical records and diagnostic images remain the property of Tel Aviv Vision Center.
6. This document complies with the Israeli Value Added Tax Law, 1975.
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