Invoice Ophthalmologist in Japan Tokyo –Free Word Template Download with AI

Bill To (Patient)

Name: Mr. Kenji Tanaka

Address: 2-4-1 Roppongi, Minato-ku

Tokyo, Japan 106-0032

Health Insurance ID: 123-45-678901

Insurance Provider: Tokyo Metropolitan Government Health Insurance

Attending Physician

Dr. Sarah Jenkins, M.D., Ph.D.

Board Certified Ophthalmologist

Specialization: Retinal Diseases & Vitreoretinal Surgery

License No: 16-0012345

Description of Ophthalmological Services Rendered

The following invoice details the comprehensive eye care services provided at our Tokyo facility. These charges reflect the standard medical fees for specialized ophthalmology procedures, diagnostic imaging, and pharmaceutical dispensing as per the Japanese Ministry of Health, Labour and Welfare guidelines.

Item	Service Description	Code	Unit Price (JPY)	Qty	Total (JPY)
1	Initial Comprehensive Ophthalmological Examination including visual acuity testing, refraction, and slit-lamp biomicroscopy.	10001	¥3,500	1	¥3,500
2	Optical Coherence Tomography (OCT) of the macula and optic nerve head for detailed retinal layer analysis.	20045	¥4,200	1	¥4,200
3	Dilated Fundus Examination with mydriatic drops to assess the peripheral retina and optic disc health.	10055	¥1,800	1	¥1,800
4	Non-contact Tonometry for intraocular pressure measurement to screen for glaucoma.	10022	¥800	1	¥800
5	Prescription of anti-inflammatory eye drops (Loteprednol Etabonate 0.5%) for post-examination irritation.	30112	¥1,200	1	¥1,200
6	Consultation fee for diagnosis of early-stage Dry Age-Related Macular Degeneration (AMD).	10005	¥2,500	1	¥2,500

Subtotal (Medical Services) ¥14,000 Consumables & Materials ¥500 Consumption Tax (10%) ¥1,450 Health Insurance Deduction (70% Covered) -¥10,150 Patient Out-of-Pocket Amount ¥5,800 Payment Terms and Important Notes

Currency: All amounts are listed in Japanese Yen (JPY). Payment is expected in local currency.
Insurance: This invoice reflects the standard 30% co-payment rate for patients under the Japanese National Health Insurance system. If you are a foreign resident without Japanese health insurance, the full subtotal plus tax is due.
Payment Methods: We accept cash, major credit cards (Visa, Mastercard, JCB), and bank transfers. For bank transfers, please reference the Invoice Number in the memo field.
Bank Details:
Bank Name: Mizuho Bank, Shinjuku Branch
Account Type: Ordinary
Account Number: 1234567
Account Name: Shinjuku Vision Care Center
Privacy: In accordance with the Japanese Act on the Protection of Personal Information, your medical data and billing information are kept strictly confidential.
Follow-up: Please schedule your next ophthalmology review appointment within 3 months to monitor the progression of your condition.

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