Invoice Ophthalmologist in Myanmar Yangon –Free Word Template Download with AI
Department of Ophthalmology
123 Bogyoke Aung San Road, Kamayut Township
Yangon, Myanmar 11181
Tel: +95 1 234 5678 | Email: [email protected]
Tax Registration No: 1234567890
Invoice Number: INV-2023-10-045
Date of Issue: October 24, 2023
Due Date: November 07, 2023
Service Location: Yangon, Myanmar
Bill To:
Patient Name: U Kyaw Min
Address: 45/2 Inya Road, Insein Township
Yangon, Myanmar
Phone: +95 9 123 456 789
Insurance Provider: Yangon Health Assurance Ltd.
Policy Number: YHA-998877
Service Details:
Attending Ophthalmologist: Dr. Thida Aye, MBBS, MS (Ophth)
Consultation Date: October 20, 2023
Diagnosis Code (ICD-10): H26.9 (Cataract, unspecified)
Procedure Code: 66984 (Cataract extraction)
Facility: Yangon Vision Care Center
| # | Description of Ophthalmic Services | Quantity | Unit Price (MMK) | Total (MMK) |
|---|---|---|---|---|
| 1 |
Comprehensive Ophthalmological Examination Initial consultation with specialist Ophthalmologist in Yangon. Includes visual acuity testing, slit-lamp examination, tonometry (eye pressure), and dilated fundus examination to assess retinal health. |
1 | 150,000 | 150,000 |
| 2 |
Phacoemulsification Cataract Surgery Advanced surgical procedure performed by Dr. Thida Aye. Includes removal of cloudy natural lens and insertion of premium multifocal intraocular lens (IOL). Performed at Yangon Vision Care Surgical Suite. |
1 | 2,500,000 | 2,500,000 |
| 3 |
Premium Multifocal Intraocular Lens (IOL) High-quality imported lens implant designed to provide clear vision at distance, intermediate, and near ranges, reducing dependency on glasses post-surgery. |
1 | 1,200,000 | 1,200,000 |
| 4 |
Post-Operative Follow-up Consultations Package includes three follow-up visits with the Ophthalmologist at 1 day, 1 week, and 1 month post-surgery to monitor healing and visual recovery in Yangon. |
3 | 50,000 | 150,000 |
| 5 |
Prescription Medications Antibiotic eye drops (Moxifloxacin), Anti-inflammatory steroid drops (Prednisolone), and Lubricating eye drops for post-operative care. |
1 | 85,000 | 85,000 |
| 6 |
Diagnostic Imaging (OCT Scan) Optical Coherence Tomography scan of the macula and optic nerve head to ensure structural integrity before and after surgical intervention. |
1 | 120,000 | 120,000 |
| Subtotal: | 4,205,000 MMK |
| Discount (Insurance Adjustment): | - 420,500 MMK |
| Service Tax (5%): | 189,225 MMK |
| Grand Total Due: | 3,973,725 MMK |
Payment Instructions & Terms
Currency: All amounts are quoted in Myanmar Kyat (MMK).
Bank Transfer: Please remit payment to Yangon Vision Care Specialists via KBZ Bank.
- Bank Name: KBZ Bank
- Account Name: Yangon Vision Care Specialists Co., Ltd.
- Account Number: 0123-4567-8901-2345
- Branch: Bogyoke Aung San Road Branch, Yangon
Payment Deadline: Payment is due within 14 days of the invoice date. Late payments may incur a 2% monthly interest charge.
Receipt: An official receipt will be issued upon confirmation of payment. Please quote the Invoice Number (INV-2023-10-045) in your payment reference.
Important Notes for Patient
This invoice covers all ophthalmological services rendered at our Yangon facility. The attending Ophthalmologist has confirmed that the procedures were medically necessary. Please retain this document for your personal records and insurance claims. If you have any questions regarding the charges or the medical services provided, please contact our billing department at +95 1 234 5678 or visit our office in Yangon during business hours (9:00 AM - 5:00 PM, Monday to Saturday).
Thank you for trusting Yangon Vision Care Specialists with your eye health.
Authorized Signature
Dr. Thida Aye
Lead Ophthalmologist
Patient Acknowledgement
U Kyaw Min
Date: _______________
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