Invoice Ophthalmologist in Qatar Doha –Free Word Template Download with AI
Specialized Ophthalmology Clinic
Building 15, Street 42, Zone 60
Al Sadd District, Doha, Qatar
P.O. Box: 23456
Commercial Registration: CR-2024-QA-789012
VAT Registration: QR-345678901234003
Phone: +974 4456 7890 | Email: [email protected]
Invoice Number: INV-2024-0892
Date of Issue: January 15, 2024
Due Date: February 15, 2024
Payment Terms: Net 30 Days
Currency: Qatari Riyal (QAR)
BILL TO:
Patient Name: Ahmed Mohammed Al-Thani
Insurance Provider: Bupa Qatar
Policy Number: BUPA-QA-789456123
Address: Villa 23, Street 567, Al Waab, Doha, Qatar
Contact: +974 3345 6789
National ID: 2990XXXXXXX
| # | Description of Ophthalmology Services | Date of Service | Quantity | Unit Price (QAR) | Total Amount (QAR) |
|---|---|---|---|---|---|
| 1 | Comprehensive Ophthalmological Examination including visual acuity testing, refraction assessment, and anterior segment evaluation by certified Ophthalmologist | Jan 10, 2024 | 1 | 350.00 | 350.00 |
| 2 | Dilated Fundus Examination with retinal imaging and optic nerve assessment for diabetic retinopathy screening | Jan 10, 2024 | 1 | 450.00 | 450.00 |
| 3 | Optical Coherence Tomography (OCT) Scan - Macula and Optic Nerve Head Analysis | Jan 10, 2024 | 1 | 600.00 | 600.00 |
| 4 | Intraocular Pressure Measurement (Tonometry) for glaucoma monitoring and assessment | Jan 10, 2024 | 1 | 150.00 | 150.00 |
| 5 | Corneal Topography Mapping for refractive surgery evaluation and keratoconus screening | Jan 10, 2024 | 1 | 500.00 | 500.00 |
| 6 | Prescription for corrective lenses including detailed specifications for progressive multifocal glasses | Jan 10, 2024 | 1 | 100.00 | 100.00 |
| 7 | Follow-up consultation with Ophthalmologist for treatment plan discussion and medication prescription | Jan 12, 2024 | 1 | 250.00 | 250.00 |
| 8 | Prescription medication: Artificial tears (preservative-free) and anti-inflammatory eye drops | Jan 12, 2024 | 2 | 85.00 | 170.00 |
| Subtotal: | 2,570.00 QAR |
| VAT (5%): | 128.50 QAR |
| Insurance Coverage: | (2,000.00) QAR |
| Amount Due: | 700.50 QAR |
PAYMENT INFORMATION:
Bank Name: Qatar National Bank (QNB)
Account Name: Doha Vision Center W.L.L.
IBAN: QA30QNBA0000123456789012
SWIFT/BIC: QNBAAQDA
Branch: Al Sadd Branch, Doha, Qatar
Reference: Please include Invoice Number INV-2024-0892
Payment can also be made via credit card (Visa, MasterCard, Amex) or cash at our clinic reception in Doha.
IMPORTANT NOTES:
1. This invoice is issued in accordance with the Qatar Tax Authority regulations and includes the mandatory 5% Value Added Tax (VAT) as per Qatar's VAT Law.
2. All ophthalmology services were performed by licensed Ophthalmologists registered with the Qatar Council for Healthcare Practitioners (QCHP).
3. Please present this invoice along with your insurance card when submitting claims to your insurance provider in Qatar.
4. Payment is due within 30 days from the date of issue. Late payments may incur a penalty of 1% per month as per Qatar commercial regulations.
5. For any queries regarding this invoice or your ophthalmology treatment, please contact our billing department at +974 4456 7890 or email [email protected].
6. This document serves as an official receipt for tax and insurance purposes in the State of Qatar.
Authorized Signature:
Dr. Sarah Al-Mansouri
Chief Ophthalmologist
QCHP License: OPH-2024-5678
Patient Acknowledgment:
_________________________
Date: _________________
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