Invoice Ophthalmologist in Saudi Arabia Jeddah –Free Word Template Download with AI
Specialized Ophthalmology Clinic
Al Hamra District, King Fahd Road
Jeddah, Makkah Province, Saudi Arabia
Phone: +966 12 555 0123
Email: [email protected]
VAT Registration Number: 300123456789003
Commercial Registration (CR): 2010001234567
Invoice Number: INV-2023-0892
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Service Period: October 2023
Billed To:
Patient Name: Ahmed Mohammed Al-Fahad
National ID / Iqama: 1098765432
Address: Al Rawdah District, Jeddah, Saudi Arabia
Phone: +966 50 123 4567
Insurance Provider: Bupa Arabia (Policy #BP-987654)
Professional Ophthalmology Services Rendered
This invoice details the comprehensive eye care services provided by our board-certified Ophthalmologist at our Jeddah facility. All procedures adhere to the highest standards of medical practice in Saudi Arabia.
| # | Description of Service | Date | Qty | Unit Price (SAR) | Total (SAR) |
|---|---|---|---|---|---|
| 1 | Comprehensive Dilated Eye Examination by Senior Ophthalmologist | Oct 10, 2023 | 1 | 350.00 | 350.00 |
| 2 | Optical Coherence Tomography (OCT) Scan - Retinal Imaging | Oct 10, 2023 | 1 | 450.00 | 450.00 |
| 3 | Corneal Topography Mapping | Oct 10, 2023 | 1 | 300.00 | 300.00 |
| 4 | Glaucoma Screening (Tonometry & Visual Field Test) | Oct 10, 2023 | 1 | 250.00 | 250.00 |
| 5 | Prescription Eyeglasses (High-Index Lenses with Anti-Reflective Coating) | Oct 15, 2023 | 1 | 850.00 | 850.00 |
| 6 | Follow-up Consultation with Ophthalmologist | Oct 20, 2023 | 1 | 200.00 | 200.00 |
| 7 | Prescription Medication (Lubricating Eye Drops & Antibiotic Ointment) | Oct 20, 2023 | 2 | 75.00 | 150.00 |
| Subtotal: | 2,550.00 SAR |
| VAT (15%): | 382.50 SAR |
| Total Amount Due: | 2,932.50 SAR |
Terms and Conditions:
- This invoice is issued in accordance with the regulations of the Zakat, Tax and Customs Authority (ZATCA) in Saudi Arabia.
- Payment is due within 30 days of the invoice date. Late payments may incur a 2% monthly interest charge.
- Accepted payment methods include bank transfer, credit card, and cash at our Jeddah clinic.
- For insurance claims, please submit this invoice along with the detailed medical report to your provider.
- All services were performed by licensed Ophthalmologists registered with the Saudi Commission for Health Specialties (SCFHS).
- Red Sea Vision Center reserves the right to request additional documentation for insurance verification.
- Any discrepancies in this invoice should be reported within 14 days of receipt.
Payment Instructions:
Bank Name: Al Rajhi Bank
Account Name: Red Sea Vision Center LLC
IBAN: SA03 8000 0000 6080 1016 7519
SWIFT Code: RJHISARIXXX
Medical Disclaimer:
This invoice represents payment for medical services rendered and does not constitute a guarantee of specific medical outcomes. All treatments were provided based on professional medical judgment in accordance with international ophthalmology standards.
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