Invoice Ophthalmologist in South Korea Seoul –Free Word Template Download with AI
123 Gangnam-daero, Gangnam-gu
Seoul, South Korea 06000
Tel: +82-2-555-0199
Email: [email protected]
Business Registration No: 123-45-67890
INVOICE
Invoice Number: INV-2023-SE-8842
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Currency: KRW (South Korean Won)
Patient Information| Name: | Mr. James Anderson | Nationality: | United States |
| Address: | 45 Itaewon-ro, Yongsan-gu, Seoul, South Korea | Phone: | +82-10-1234-5678 |
| Insurance Provider: | Global Health International | Policy Number: | GH-998877-KR |
The following invoice details the comprehensive ophthalmological care provided at our facility in Seoul, South Korea. Our clinic adheres to the highest standards of medical practice recognized by the Korean Medical Association. The services listed below were performed by Dr. Min-Ji Park, a board-certified Ophthalmologist specializing in refractive surgery and retinal diseases. This document serves as the official financial record for the medical treatment received.
| Item | Description of Service | Date | Quantity | Unit Price (KRW) | Total (KRW) |
|---|---|---|---|---|---|
| 1 |
Comprehensive Ophthalmic Examination Initial consultation including medical history review, visual acuity testing, and slit-lamp examination. Conducted in English to accommodate international patient needs in Seoul. |
Oct 20, 2023 | 1 | 150,000 | 150,000 |
| 2 |
Advanced Retinal Imaging (OCT) Optical Coherence Tomography scan to assess the structural integrity of the retina and optic nerve. Essential for diagnosing macular degeneration and glaucoma. |
Oct 20, 2023 | 1 | 220,000 | 220,000 |
| 3 |
Corneal Topography Detailed mapping of the corneal surface curvature. Required for pre-operative assessment for potential refractive correction procedures. |
Oct 20, 2023 | 1 | 180,000 | 180,000 |
| 4 |
Prescription Eyewear Dispensing Supply of high-index anti-reflective lenses and titanium frame. Includes precise fitting and adjustment by certified opticians. |
Oct 22, 2023 | 1 | 450,000 | 450,000 |
| 5 |
Follow-up Consultation Post-dispensing review to ensure visual comfort and proper adaptation to new prescription. |
Oct 24, 2023 | 1 | 80,000 | 80,000 |
| Subtotal: | 1,080,000 | ||||
| VAT (10%): | 108,000 | ||||
| GRAND TOTAL: | 1,188,000 KRW | ||||
1. Payment Method: Payment can be made via bank transfer to Seoul Vision & Eye Care Center (IBK Enterprise Bank, Account: 1234-5678-9012), credit card, or cash at the clinic reception in Gangnam-gu, Seoul.
2. Currency: All amounts are denominated in South Korean Won (KRW). If payment is made in foreign currency, the exchange rate will be determined on the date of transaction.
3. Late Fees: A late fee of 5% will be applied to any outstanding balance after the due date of November 24, 2023.
4. Insurance Claims: This invoice is formatted to meet the requirements of international insurance providers. Please submit this document along with the detailed medical report for reimbursement processing.
Medical DisclaimerThis invoice represents the financial transaction for medical services provided by a licensed Ophthalmologist in South Korea. It does not constitute a guarantee of medical outcomes. The treatment plan was developed based on the clinical judgment of the attending physician at the time of service.
Authorized Signature
Dr. Min-Ji Park, M.D.
Chief Ophthalmologist
Patient Acknowledgement
Signature: ______________________
Date: ______________________
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