Invoice Ophthalmologist in Russia Saint Petersburg –Free Word Template Download with AI
Specialized Ophthalmology Clinic
19th Line, Vasilievsky Island, House 42
Saint Petersburg, Russia, 199178
Phone: +7 (812) 555-01-99
Email: [email protected]
INN: 7801234567 | KPP: 780101001
Invoice Number: INV-RU-SPB-2023-0892
Date of Issue: October 24, 2023
Due Date: November 07, 2023
Payment Status: Pending
Bill ToPatient Name: Ivan Petrovich Sokolov
Address: Nevsky Prospekt, 120, Apt 45, Saint Petersburg, Russia, 191025
Phone: +7 (921) 555-12-34
Email: [email protected]
Policy Number (if applicable): MED-INS-449201
Ophthalmology Services RenderedThe following invoice details the professional medical services provided by our board-certified ophthalmologists at our Saint Petersburg facility. These charges cover diagnostic procedures, surgical interventions, and post-operative care as outlined in the patient's treatment plan.
| # | Description of Service | Date | Qty | Unit Price (RUB) | Total (RUB) |
|---|---|---|---|---|---|
| 1 |
Comprehensive Ophthalmological Examination Includes visual acuity testing, refraction, slit-lamp biomicroscopy, and intraocular pressure measurement. |
Oct 20, 2023 | 1 | 4,500.00 | 4,500.00 |
| 2 |
Optical Coherence Tomography (OCT) High-resolution imaging of the retina and optic nerve head to assess macular health. |
Oct 20, 2023 | 2 | 3,200.00 | 6,400.00 |
| 3 |
Phacoemulsification with IOL Implantation Cataract surgery performed on the right eye using advanced femtosecond laser technology. Includes premium multifocal intraocular lens. |
Oct 22, 2023 | 1 | 85,000.00 | 85,000.00 |
| 4 |
Post-Operative Consultation Follow-up examination to monitor healing progress and visual recovery. |
Oct 23, 2023 | 1 | 2,500.00 | 2,500.00 |
| 5 |
Prescription Medication Kit Antibiotic and anti-inflammatory eye drops for post-surgical care. |
Oct 22, 2023 | 1 | 3,800.00 | 3,800.00 |
Payment Instructions & Terms
Please remit payment within 14 days of the invoice date. As this invoice pertains to medical services rendered in Saint Petersburg, Russia, payments can be made via bank transfer to our local account or via major credit cards at our clinic reception.
Bank Details:
Bank Name: Sberbank of Russia
Account Name: Neva Vision Center LLC
Account Number: 40702810500000012345
BIC: 044525225
Correspondent Account: 30101810400000000225
Important Note: This invoice serves as an official receipt for tax purposes in the Russian Federation. Please retain this document for your personal records and for submission to your insurance provider if required. Late payments may incur a penalty fee of 0.1% per day.
Authorized Signature
Dr. Elena Volkova, Chief Ophthalmologist
Patient Acknowledgement
Ivan P. Sokolov
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