Invoice Ophthalmologist in Nigeria Lagos –Free Word Template Download with AI

Billed To:

Mr. Chukwudi Okafor

12 Admiralty Way, Lekki Phase 1

Lagos, Nigeria

Phone: +234 801 234 5678

Email: [email protected]

Insurance / HMO Details:

Provider: Reliance HMO

Policy Number: RHMO-LAG-77829

Group ID: G-44921

Authorization Code: AUTH-2024-5591

#	Description of Ophthalmology Services	Date of Service	Unit Price (NGN)	Total (NGN)
1	Comprehensive Dilated Eye Examination Initial consultation with senior Ophthalmologist including visual acuity testing, slit-lamp biomicroscopy, tonometry, and dilated fundus examination. Performed at Lagos Vision Care Specialists clinic.	Oct 24, 2024	₦45,000.00	₦45,000.00
2	Optical Coherence Tomography (OCT) Scan High-resolution cross-sectional imaging of the retina and optic nerve head to assess macular health and detect early signs of glaucoma or diabetic retinopathy.	Oct 24, 2024	₦35,000.00	₦35,000.00
3	Prescription Eyewear Dispensing High-index anti-reflective coated lenses with premium frame selection. Includes precise measurement and fitting by certified optometrist under ophthalmologist supervision.	Oct 24, 2024	₦85,000.00	₦85,000.00
4	Glaucoma Screening & Management Consultation Follow-up assessment including visual field testing (perimetry) and optic nerve evaluation. Includes prescription of topical medication and patient education on disease management.	Oct 24, 2024	₦30,000.00	₦30,000.00
5	Pharmaceutical Supplies Prescribed ophthalmic medications: Timolol maleate eye drops (0.5%), Artificial tears (preservative-free), and antibiotic ointment. Dispensed by in-house pharmacy.	Oct 24, 2024	₦18,500.00	₦18,500.00

Subtotal: ₦213,500.00 HMO Coverage (70%): -₦149,450.00 Patient Responsibility (30%): ₦64,050.00 7% VAT (on patient portion): ₦4,483.50 TOTAL DUE: ₦68,533.50

Payment Instructions

Please remit payment within 14 days of invoice date to avoid late fees. Lagos Vision Care Specialists accepts the following payment methods:

Bank Transfer: GTBank, Account Name: Lagos Vision Care Specialists Ltd, Account Number: 0123456789
Card Payment: Visa/Mastercard accepted at clinic or via secure online portal
Mobile Money: Transfer via USSD or banking app using reference code LVC-0892
Cheque: Payable to "Lagos Vision Care Specialists Ltd", deliverable to our Victoria Island office

Note: For HMO claims, please ensure all required documentation is submitted within 30 days. Our billing department will coordinate directly with your insurance provider.

Important Notes & Terms

1. This invoice represents professional ophthalmology services rendered at our Lagos facility in accordance with Nigerian Medical Council guidelines and standards of care.

2. All prices are quoted in Nigerian Naira (NGN) and are subject to applicable taxes as mandated by the Federal Inland Revenue Service.

3. Late payments will incur a penalty of 2% per month on the outstanding balance after the due date.

4. Please retain this invoice for your records and for any insurance reimbursement claims. A duplicate copy can be requested via email.

5. For questions regarding this invoice or your eye care treatment plan, please contact our billing department at +234 803 555 1234 or visit us during business hours (Monday-Friday, 8:00 AM - 5:00 PM).

6. Lagos Vision Care Specialists is committed to providing world-class ophthalmology services across Nigeria, with specialized care for cataracts, glaucoma, retinal diseases, and refractive errors.

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