Invoice Ophthalmologist in Saudi Arabia Riyadh –Free Word Template Download with AI
Specialized Ophthalmologist Clinic
Al Olaya District, King Fahd Road
Riyadh, 12214, Saudi Arabia
Phone: +966 11 234 5678
Email: [email protected]
VAT Registration Number: 300012345600003
Commercial Registration (CR): 1010XXXXXX
Invoice Number: INV-2023-10-045
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Service Date: October 20, 2023
Patient / Client Information|
Name: Ahmed Al-Fahad National ID / Iqama: 1098765432 Insurance Provider: Bupa Arabia Policy Number: BUPA-998877 Group Number: GRP-5544 |
Address: Al Malqa, Riyadh, Saudi Arabia Phone: +966 50 123 4567 Email: [email protected] Referring Physician: Dr. Sarah Al-Saud (GP) |
The following invoice details the professional medical services provided by our board-certified Ophthalmologist in Riyadh, Saudi Arabia. These services include comprehensive eye examinations, diagnostic imaging, and specialized treatments in accordance with the regulations set by the Saudi Commission for Health Specialties (SCFHS).
| Item | Description of Service | Code | Qty | Unit Price (SAR) | Total (SAR) |
|---|---|---|---|---|---|
| 1 | Comprehensive Ophthalmological Examination including visual acuity, refraction, and slit-lamp biomicroscopy. | OPH-001 | 1 | 350.00 | 350.00 |
| 2 | Optical Coherence Tomography (OCT) Scan of the retina and optic nerve head. | IMG-045 | 1 | 450.00 | 450.00 |
| 3 | Dilated Fundus Examination to assess the health of the retina and macula. | OPH-012 | 1 | 200.00 | 200.00 |
| 4 | Prescription of corrective lenses (Glasses) following refraction analysis. | RX-005 | 1 | 100.00 | 100.00 |
| 5 | Consultation for Glaucoma screening and intraocular pressure measurement (Tonometry). | OPH-020 | 1 | 250.00 | 250.00 |
Amount in words: One Thousand Five Hundred Fifty-Two Saudi Riyals and Fifty Halalas only.
Payment Terms and ConditionsThis invoice is issued in compliance with the Zakat, Tax and Customs Authority (ZATCA) regulations in Saudi Arabia. Payment is due within 30 days from the date of issue. Please ensure that the invoice number is referenced on all payments.
Bank Transfer Details:
Bank Name: Al Rajhi Bank
Account Name: Riyadh Vision & Eye Care Center
IBAN: SA03 8000 0000 6080 1016 7519
SWIFT Code: RJHISARI
For insurance claims, please submit this original invoice along with the medical report to your respective insurance provider. Our billing department is available to assist with any queries regarding this invoice or the services provided by our Ophthalmologist team in Riyadh.
Authorized Signature
Dr. Khalid Al-Mutairi
Chief Ophthalmologist
Received By
__________________________
Date: ____________________
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