Invoice Ophthalmologist in Mexico Mexico City –Free Word Template Download with AI
Av. Paseo de la Reforma 222, Col. Juárez
Cuauhtémoc, 06600 Mexico City, CDMX, Mexico
RFC: VCO-850101-XYZ
Tel: +52 (55) 1234-5678
Email: [email protected]
INVOICE
Invoice Number: INV-2023-10-045
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Payment Terms: Net 30 Days
Bill To (Patient / Insurance Provider)
Name: Juan Carlos Hernández López
Address: Calle Insurgentes Sur 1602, Col. Del Valle
Benito Juárez, 03100 Mexico City, CDMX, Mexico
RFC: HELO-780515-AB1
Insurance Policy: AXA Seguros - Policy #99887766
The following invoice details the professional medical services provided by our board-certified Ophthalmologist at our clinic located in the heart of Mexico City. These services include comprehensive diagnostic evaluations, surgical procedures, and post-operative care in accordance with the standards set by the Mexican Medical Association and the Ministry of Health (SSA).
| # | Description of Service | Code (CIE-10) | Qty | Unit Price (MXN) | Total (MXN) |
|---|---|---|---|---|---|
| 1 | Comprehensive Ophthalmological Examination: Initial consultation with a specialist Ophthalmologist. Includes visual acuity testing, refraction, slit-lamp examination, and intraocular pressure measurement. Performed at our Mexico City facility. | H53.9 | 1 | 1,500.00 | 1,500.00 |
| 2 | Optical Coherence Tomography (OCT): Advanced retinal imaging to assess macular degeneration and glaucoma risk. High-resolution cross-sectional imaging of the retina provided by our specialized equipment. | H35.3 | 1 | 2,200.00 | 2,200.00 |
| 3 | Phacoemulsification with IOL Implantation: Cataract surgery performed by Dr. Elena Rodriguez, Lead Ophthalmologist. Includes pre-operative anesthesia, surgical procedure, and premium intraocular lens implantation. | H26.9 | 1 | 25,000.00 | 25,000.00 |
| 4 | Post-Operative Follow-up Consultations: Three scheduled follow-up visits to monitor healing and visual recovery after cataract surgery. Includes medication prescription and adjustment. | Z48.8 | 3 | 800.00 | 2,400.00 |
| 5 | Prescription Eyewear Dispensing: Provision of high-index lenses and frame fitting based on the post-surgical prescription issued by the Ophthalmologist. | Z98.2 | 1 | 3,500.00 | 3,500.00 |
Subtotal: $34,600.00 MXN
IVA (16% VAT): $5,536.00 MXN
Grand Total: $40,136.00 MXN
Payment InstructionsPlease remit payment within 30 days of the invoice date. Payments can be made via bank transfer to our account in Mexico City:
- Bank: BBVA México
- Account Name: Visión Central Ophthalmology Center S.A. de C.V.
- CLABE: 012180001234567890
- Reference: INV-2023-10-045
For credit card payments, please contact our billing department at +52 (55) 1234-5678. We accept Visa, Mastercard, and American Express.
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