Invoice Ophthalmologist in Peru Lima –Free Word Template Download with AI

BILL TO:

Patient Name: Carlos Alberto Mendoza Ruiz

Address: Jr. Ancash 123, Miraflores, Lima, Peru

DNI (National ID): 78945612

Insurance Provider: Seguros Pacífico del Perú S.A.

Policy Number: POL-99887766

#	Description of Ophthalmological Services	Quantity	Unit Price (PEN)	Total (PEN)
1	Comprehensive Ophthalmological Examination Includes visual acuity testing, refraction, slit-lamp examination, and intraocular pressure measurement. Performed by Dr. Elena Vargas, Senior Ophthalmologist.	1	250.00	250.00
2	Dilated Fundus Examination Detailed retinal assessment using mydriatic drops to evaluate the optic nerve, macula, and peripheral retina for signs of diabetic retinopathy or glaucoma.	1	180.00	180.00
3	Optical Coherence Tomography (OCT) High-resolution cross-sectional imaging of the retina to detect macular degeneration, edema, or other structural abnormalities.	1	350.00	350.00
4	Corneal Topography Advanced mapping of the corneal surface to assess astigmatism, keratoconus, or suitability for refractive surgery.	1	220.00	220.00
5	Prescription Eyeglasses Consultation Final prescription verification and lens recommendation based on diagnostic findings.	1	100.00	100.00
6	Administrative Fee Processing fee for medical records, insurance coordination, and invoice generation in compliance with Peruvian tax regulations.	1	50.00	50.00

Subtotal: S/ 1,150.00 IGV (18% VAT - Peru): S/ 207.00 TOTAL AMOUNT DUE: S/ 1,357.00

Payment Instructions & Important Notes:

This invoice is issued in accordance with the tax regulations of the Republic of Peru. Payment is expected within 14 days from the date of issue. Late payments may incur a penalty of 1.5% per month on the outstanding balance.

Accepted Payment Methods:

Bank Transfer: BCP (Banco de Crédito del Perú) - Account No. 194-567890-1-23
Credit/Debit Card: Visa, Mastercard, American Express (processed securely online)
Cash: Accepted at our clinic in San Isidro, Lima, during business hours (Mon-Fri: 8:00 AM - 7:00 PM, Sat: 9:00 AM - 1:00 PM)

Please include the invoice number (F001-00458921) as a reference when making any payment. For insurance claims, this document serves as the official receipt and can be submitted directly to your provider. Our billing department is available to assist with any questions regarding this invoice or your ophthalmological care.

Medical Disclaimer: This invoice reflects services rendered by licensed ophthalmologists at Clínica Ocular Lima Central. All procedures were performed following international standards of eye care and Peruvian health regulations. For medical inquiries, please contact our clinical team directly.

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