Invoice Ophthalmologist in Malaysia Kuala Lumpur –Free Word Template Download with AI
Dr. A. Rahman, MBBS, FRCS (Ophth)
Consultant Ophthalmologist
Level 12, Menara KL Medical Tower
123 Jalan Tun Razak, 50400 Kuala Lumpur
Wilayah Persekutuan Kuala Lumpur, Malaysia
Tel: +603-2100 5555 | Email: [email protected]
Company Reg: 201501012345 (1234567-X)
Invoice #: INV-2023-10-089
Date: October 24, 2023
Due Date: November 24, 2023
Status: Unpaid
Bill To:
Patient Name: Mr. Tan Wei Ming
NRIC/Passport: 880512-14-5678
Address: 45 Jalan Ampang, 50450 Kuala Lumpur, Malaysia
Contact: +6012-345 6789
Insurance Provider: Great Eastern Life Assurance
Policy Number: GE-OPH-987654321
Group ID: KL-CORP-2023
Claim Reference: CLM-20231024-001
| # | Description of Ophthalmology Services | Quantity | Unit Price (MYR) | Total (MYR) |
|---|---|---|---|---|
| 1 |
Comprehensive Ophthalmic Examination Initial consultation with Dr. A. Rahman including visual acuity testing, slit-lamp examination, and intraocular pressure measurement. Performed at our Kuala Lumpur clinic. |
1 | 250.00 | 250.00 |
| 2 |
Dilated Fundus Examination Pharmacological dilation of pupils followed by detailed retinal and optic nerve head assessment using indirect ophthalmoscopy. |
1 | 150.00 | 150.00 |
| 3 |
Optical Coherence Tomography (OCT) High-resolution cross-sectional imaging of the retina and macula to assess for macular degeneration, diabetic retinopathy, or glaucomatous changes. |
1 | 350.00 | 350.00 |
| 4 |
Visual Field Test (Perimetry) Automated static perimetry to evaluate peripheral vision and detect visual field defects associated with glaucoma or neurological conditions. |
1 | 200.00 | 200.00 |
| 5 |
Corneal Topography Detailed mapping of the corneal surface curvature for refractive error analysis and pre-operative assessment. |
1 | 180.00 | 180.00 |
| 6 |
Prescription Eyewear Consultation Refraction and prescription determination for corrective lenses. Includes binocular vision assessment. |
1 | 120.00 | 120.00 |
| 7 |
Diagnostic Imaging - Fundus Photography High-resolution digital imaging of the retina for documentation and monitoring of ocular conditions. |
1 | 100.00 | 100.00 |
| 8 |
Medical Report Preparation Detailed clinical report for insurance claims and referral purposes, prepared by the consulting Ophthalmologist. |
1 | 150.00 | 150.00 |
| Subtotal: | MYR 1,500.00 |
| Service Tax (6%): | MYR 90.00 |
| Insurance Adjustment: | MYR -300.00 |
| Grand Total: | MYR 1,290.00 |
Payment Terms & Conditions:
1. Payment is due within 30 days from the invoice date. Late payments may incur a 2% monthly interest charge.
2. Please make payments via bank transfer to our account at Maybank Berhad, Kuala Lumpur Branch:
Account Name: KL Vision Specialist Centre Sdn Bhd
Account Number: 5678 9012 3456
SWIFT Code: MBBEMYKL
3. For insurance claims, please submit this invoice along with the completed claim form and medical report to your insurance provider.
4. All services rendered are provided by qualified Ophthalmologists registered with the Malaysian Medical Council.
5. This invoice is valid for tax purposes in Malaysia and complies with the Royal Malaysian Customs Department requirements.
6. If you have any questions regarding this invoice or the ophthalmology services provided, please contact our billing department at +603-2100 5555.
7. Please quote the Invoice Number (INV-2023-10-089) in all correspondence and payments.
Authorized Signature:
Dr. A. RahmanConsultant Ophthalmologist
KL Vision Specialist Centre ⬇️ Download as DOCX Edit online as DOCX
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