Invoice Ophthalmologist in Nigeria Abuja –Free Word Template Download with AI
Lead Ophthalmologist: Dr. Amina Bello, MBBS, FWACS, FCOphth
Plot 142, Ademola Adetokunbo Crescent, Wuse II
Federal Capital Territory, Abuja, Nigeria
Tel: +234 9 460 1234 | Email: [email protected]
TIN: 12345678-0001 | RC: 987654
Invoice Number: AVC-2023-0892
Date Issued: October 24, 2023
Due Date: November 07, 2023
Payment Status: Pending
Billed To:
Mr. Chukwudi Okafor
15 Aguiyi Ironsi Street, Maitama
Abuja, FCT, Nigeria
Phone: +234 803 555 1234
Email: [email protected]
Insurance / Third Party Details:
Provider: Leadway Assurance Plc
Policy Number: LW-OPH-998877
Group ID: GOV-FCT-2023
Authorization Ref: AUTH-445566
| # | Description of Ophthalmological Services | Quantity | Unit Price (NGN) | Total (NGN) |
|---|---|---|---|---|
| 1 |
Comprehensive Ophthalmic Examination Includes visual acuity testing, refraction, slit-lamp biomicroscopy, and intraocular pressure measurement. Conducted by senior Ophthalmologist at Abuja Vision Care. |
1 | 25,000.00 | 25,000.00 |
| 2 |
Dilated Fundus Examination Detailed retinal assessment using mydriatic agents to evaluate optic nerve health and retinal vasculature. Essential for diabetic retinopathy screening in Nigeria. |
1 | 15,000.00 | 15,000.00 |
| 3 |
Optical Coherence Tomography (OCT) High-resolution cross-sectional imaging of the retina to detect macular degeneration, glaucoma, and other retinal pathologies. |
1 | 45,000.00 | 45,000.00 |
| 4 |
Prescription Eyewear Dispensing Single-vision anti-reflective coated lenses with titanium frame. Includes fitting and adjustment by certified optometrist under Ophthalmologist supervision. |
1 | 85,000.00 | 85,000.00 |
| 5 |
Pharmacological Treatment Prescription for topical antibiotic drops (Moxifloxacin 0.5%) and lubricating eye drops for dry eye syndrome management. |
2 | 8,500.00 | 17,000.00 |
| 6 |
Follow-up Consultation Fee Scheduled post-treatment review with the Ophthalmologist to assess healing progress and adjust medication if necessary. |
1 | 15,000.00 | 15,000.00 |
Payment Instructions & Terms:
This Invoice is issued in accordance with the healthcare regulations of the Federal Capital Territory, Abuja, Nigeria. Payment is due within 14 days of the invoice date. Late payments may incur a penalty of 2% per month.
Bank Transfer Details:
Bank: Zenith Bank Plc
Account Name: Abuja Vision Care Specialists Ltd
Account Number: 1012345678
Branch: Wuse II, Abuja
Please use Invoice Number AVC-2023-0892 as the payment reference.
Cash Payments: Accepted at our reception desk in Wuse II, Abuja. Official receipts will be provided immediately.
Insurance Claims: For direct billing, please ensure your insurance authorization is valid. Our billing department will liaise with your provider in Abuja.
Medical Disclaimer: This Invoice reflects services rendered by a qualified Ophthalmologist. It does not constitute a guarantee of medical outcomes. All treatments were performed following standard ophthalmic care protocols recognized in Nigeria and internationally.
If you have any questions regarding this Invoice or the services provided by our Ophthalmologist team, please contact our billing department at +234 9 460 1234 or email [email protected].
Authorized By:
Dr. Amina Bello
Lead Ophthalmologist
Abuja Vision Care Specialists
Received By:
_________________________
Name: Mr. Chukwudi Okafor
Date: ___________________
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