Invoice Ophthalmologist in South Africa Johannesburg –Free Word Template Download with AI
Dr. Sarah Mokoena, FCOphth (SA)
Consultant Ophthalmologist
123 Sandton Drive, Sandton City
Johannesburg, Gauteng, 2196
South Africa
Tel: +27 (0)11 555 0123
Email: [email protected]
Practice Number: 123456789
HPCSA Registration: 0000000000
Bill To:Mr. Johnathan Smith
456 Rivonia Road
Rivonia, Johannesburg
Gauteng, 2128
South Africa
Medical Aid: Discovery Health
Member Number: 1234567890
Dependent Number: 01
Services Rendered by OphthalmologistThe following invoice details the professional fees charged by the Ophthalmologist for the comprehensive eye examination and subsequent treatment plan provided at our Johannesburg clinic. These services adhere to the strict medical standards required within South Africa.
| # | Description of Service | Medical Aid Code | Quantity | Amount (ZAR) |
|---|---|---|---|---|
| 1 |
Comprehensive Ophthalmic Examination Full diagnostic assessment including visual acuity testing, refraction, slit-lamp biomicroscopy, and funduscopy. This consultation is performed by a specialist Ophthalmologist to evaluate ocular health and detect early signs of pathology. |
1001 | 1 | R 1,250.00 |
| 2 |
Optical Coherence Tomography (OCT) Advanced imaging of the retina and optic nerve head. Essential for diagnosing macular degeneration and glaucoma, common conditions treated by Ophthalmologists in South Africa. |
1045 | 1 | R 850.00 |
| 3 |
Visual Field Analysis (Perimetry) Assessment of peripheral vision to monitor glaucoma progression. |
1050 | 1 | R 600.00 |
| 4 |
Prescription of Corrective Lenses Detailed prescription for progressive lenses based on the examination findings. |
1002 | 1 | R 150.00 |
| 5 |
Follow-up Consultation (Post-Procedure) Review of intraocular pressure and medication efficacy. |
1003 | 1 | R 750.00 |
Please settle this invoice within 30 days of the date issued. Payments can be made via Electronic Funds Transfer (EFT) to the bank account detailed below. Please quote your Invoice Number and Name as the payment reference.
Bank: First National Bank (FNB)
Branch: Sandton, Johannesburg
Account Name: Johannesburg Specialist Eye Care (Pty) Ltd
Account Number: 62001234567
Account Type: Business Current
SWIFT Code: FIRNZAJJ
Important Notes & Terms- Medical Aid Claims: This invoice is formatted to comply with the requirements of major South African medical aid schemes. Please submit this document along with your claim form to your provider. As an Ophthalmologist, we provide the necessary clinical notes upon request to support your claim.
- VAT Registration: This practice is VAT registered in South Africa (VAT No: 4900123456). The VAT amount included is payable to the South African Revenue Service (SARS).
- Out-of-Pocket Costs: Please note that medical aid schemes often have "Package Rates" or "Maximum Benefit Limits" for Ophthalmology services. If your medical aid pays less than the amount billed, the difference is your responsibility as the patient.
- Privacy: In accordance with the Protection of Personal Information Act (POPIA) of South Africa, your personal and medical data is handled with strict confidentiality.
- Disputes: If you have any queries regarding this invoice or the services provided by the Ophthalmologist, please contact our billing department in Johannesburg immediately.
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