Invoice Ophthalmologist in Russia Moscow –Free Word Template Download with AI
Leading Ophthalmology Clinic in Russia
12/5 Tverskaya Street, Building 3
Moscow, Russia, 125009
Tel: +7 (495) 123-45-67
Email: [email protected]
INN: 7701234567 | KPP: 770101001
Professional Ophthalmology Services
Billed To:
Alexei Petrov
45 Leninsky Prospekt, Apt 12
Moscow, Russia, 119991
Phone: +7 (916) 555-12-34
Email: [email protected]
Policy Number: MC-2024-78901
| # | Description of Ophthalmology Services | Quantity | Unit Price (RUB) | Total (RUB) |
|---|---|---|---|---|
| 1 |
Comprehensive Ophthalmological Examination Full eye health assessment including visual acuity testing, refraction analysis, intraocular pressure measurement, and slit-lamp examination performed by a certified ophthalmologist in Moscow. |
1 | 4,500.00 | 4,500.00 |
| 2 |
Dilated Fundus Examination Detailed retinal examination using mydriatic drops to assess the health of the retina, optic nerve, and macula. Essential for early detection of diabetic retinopathy and glaucoma. |
1 | 3,200.00 | 3,200.00 |
| 3 |
Optical Coherence Tomography (OCT) Advanced imaging technology to capture high-resolution cross-sectional images of the retina. Used for diagnosing macular degeneration, glaucoma, and other retinal conditions. |
1 | 5,800.00 | 5,800.00 |
| 4 |
Corneal Topography Detailed mapping of the corneal surface curvature to detect irregularities, astigmatism, and prepare for refractive surgery planning. |
1 | 4,100.00 | 4,100.00 |
| 5 |
Specialist Consultation with Senior Ophthalmologist In-depth consultation with Dr. Elena Sokolova, MD, PhD, a leading ophthalmologist in Russia Moscow, for diagnosis review and treatment plan development. |
1 | 6,500.00 | 6,500.00 |
| 6 |
Prescription Eyeglasses Consultation and Fitting Professional measurement and fitting service for corrective lenses based on the comprehensive examination results. |
1 | 2,800.00 | 2,800.00 |
| 7 |
Diagnostic Eye Drops and Consumables Mydriatic drops, fluorescein dye, and other medical consumables used during the examination procedures. |
1 | 900.00 | 900.00 |
| 8 |
Detailed Medical Report and Documentation Comprehensive written report of all examination findings, diagnostic results, and recommended treatment plan in accordance with Russian medical standards. |
1 | 1,500.00 | 1,500.00 |
| Subtotal: | 29,300.00 RUB |
| VAT (20%): | 5,860.00 RUB |
| Insurance Discount: | -3,000.00 RUB |
| Grand Total: | 32,160.00 RUB |
Payment Terms and Conditions
This invoice is issued by Moscow Vision Center, a licensed ophthalmology clinic operating in Russia Moscow, in accordance with the Federal Law "On the Fundamentals of Health Protection of Citizens in the Russian Federation." Payment is due within 30 days from the date of issue. Late payments may incur a penalty of 0.1% per day on the outstanding amount.
Payment Methods:
- Bank Transfer: Sberbank, Moscow Branch
- Account Number: 40702810123450001234
- BIC: 044525225
- SWIFT: SABRRUMM
- Credit/Debit Cards: Visa, MasterCard, MIR
- Cash Payment: Available at clinic reception during business hours
Important Notes:
All ophthalmology services listed on this invoice were performed by qualified medical professionals certified to practice in Russia. The Moscow Vision Center adheres to the highest international standards of eye care while complying with all Russian Federation healthcare regulations. Patients are advised to keep this invoice for insurance claims, tax purposes, and medical records. For any questions regarding this invoice or the ophthalmological services provided, please contact our billing department at +7 (495) 123-45-67 or email [email protected].
Medical Disclaimer:
This invoice documents the financial transaction for medical services rendered. It does not constitute a medical diagnosis or treatment recommendation. All medical advice and treatment plans are provided separately by the attending ophthalmologist. Patients should follow the prescribed treatment plan and attend all recommended follow-up appointments to ensure optimal eye health outcomes.
Dr. Elena Sokolova, MD, PhD
Chief Ophthalmologist
Moscow Vision Center
Signature: _________________________
Date: October 15, 2024 Received by:
Patient Name: _________________________
Signature: _________________________
Date: _________________________ ⬇️ Download as DOCX Edit online as DOCX
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