Invoice Ophthalmologist in Italy Rome –Free Word Template Download with AI
Dr. Alessandro Rossi, MD - Specialist in Ophthalmology
Via del Corso, 124, 00186 Roma RM, Italy
P.IVA / CF: IT01234567890
Email: [email protected] | Tel: +39 06 1234 5678
PEC: [email protected]
Invoice Number: 2023-10-045
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Payment Terms: Net 30 Days
Bill To
Signora Maria Bianchi
Via Nazionale, 45
00184 Roma RM, Italy
CF: BNCMRA80A01F205X
Tel: +39 333 123 4567
Service Details
Patient Name: Maria Bianchi
Date of Service: October 20, 2023
Diagnosis Code (ICD-10): H40.10 (Primary open-angle glaucoma, unspecified eye)
Referring Physician: Dr. Luca Verdi (Medico di Base)
| # | Description of Ophthalmological Services | Code (SSN/Private) | Amount (EUR) |
|---|---|---|---|
| 1 |
Comprehensive Ophthalmological Examination Includes visual acuity testing, refraction, slit-lamp biomicroscopy, and intraocular pressure measurement (tonometry). This initial consultation was conducted at our clinic in Rome to assess the patient's visual health status and identify early signs of ocular pathology. |
01.01.01 | € 85.00 |
| 2 |
Dilated Fundus Examination Pharmacological mydriasis followed by indirect ophthalmoscopy to evaluate the retina, optic nerve head, and macula. Essential for monitoring glaucomatous changes and retinal integrity in patients residing in the Rome metropolitan area. |
01.02.03 | € 45.00 |
| 3 |
Optical Coherence Tomography (OCT) High-resolution cross-sectional imaging of the retina and optic nerve fiber layer. This advanced diagnostic procedure is critical for precise measurement of retinal thickness and detection of subtle structural abnormalities. |
01.05.02 | € 120.00 |
| 4 |
Visual Field Test (Perimetry) Automated static perimetry (Humphrey Field Analyzer) to map the patient's peripheral vision. This test is vital for diagnosing and monitoring the progression of glaucoma and other neurological conditions affecting vision. |
01.04.01 | € 75.00 |
| 5 |
Corneal Topography Detailed mapping of the corneal surface curvature. Used to assess corneal shape, detect astigmatism, and screen for keratoconus. This service ensures accurate prescription data for corrective lenses. |
01.03.05 | € 60.00 |
| 6 |
Prescription of Corrective Lenses Detailed prescription for bifocal glasses based on the refraction results obtained during the examination. Includes consultation on lens options suitable for the patient's lifestyle in Rome. |
01.01.05 | € 25.00 |
| 7 |
Medical Report and Documentation Preparation of a detailed clinical report summarizing findings, diagnosis, and treatment plan. This document is required for insurance claims and coordination with the Italian National Health Service (SSN). |
01.99.01 | € 30.00 |
Payment Instructions
Please make payment within 30 days of the invoice date. Payments can be made via bank transfer or credit card at our clinic in Rome.
Bank Details:
Bank: Banca Intesa Sanpaolo
IBAN: IT60 X030 6909 6061 0000 0123 456
BIC: BCITITMM
Reference: Invoice 2023-10-045 - Bianchi Maria
Note: For tax purposes in Italy, please retain this invoice as proof of payment for medical expenses. A portion of these costs may be deductible under Italian tax law (73% deduction for medical expenses over €129.11).
Authorized Signature:
Dr. Alessandro Rossi
Ophthalmologist
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