Invoice Ophthalmologist in Sudan Khartoum –Free Word Template Download with AI
Specialized Ophthalmology Clinic
Al-Amir Muhammad Ahmad Street, Bahri
Khartoum North, Sudan
Tel: +249 183 123 456 | Email: [email protected]
Invoice #: KVC-2023-0892
Date: October 24, 2023
Due Date: November 07, 2023
Issued By (Ophthalmologist)
Dr. Ahmed El-Tayeb
Consultant Ophthalmologist & Retina Specialist
License No: SMO-OPH-4492
Member, Sudan Medical Council
Bill To (Patient)
Mr. Ibrahim Hassan
Al-Saltana District
Khartoum, Sudan
ID No: 102-4456-7890
Phone: +249 912 345 678
Statement of Ophthalmological Services
The following Invoice details the professional medical services rendered by the Ophthalmologist at our Khartoum facility. These charges cover comprehensive eye examinations, diagnostic imaging, and therapeutic interventions necessary for the maintenance of ocular health. Please review the items below carefully.
| # | Description of Service | Quantity | Unit Price (SDG) | Total (SDG) |
|---|---|---|---|---|
| 1 |
Comprehensive Ophthalmic Consultation Initial assessment by Consultant Ophthalmologist including medical history review, visual acuity testing, and slit-lamp examination. |
1 | 15,000.00 | 15,000.00 |
| 2 |
Optical Coherence Tomography (OCT) High-resolution cross-sectional imaging of the retina to assess macular health and optic nerve structure. |
1 | 25,000.00 | 25,000.00 |
| 3 |
Goldmann Applanation Tonometry Precise measurement of intraocular pressure to screen for glaucoma and monitor ocular hypertension. |
1 | 5,000.00 | 5,000.00 |
| 4 |
Dilated Fundus Examination Administration of mydriatic drops and detailed inspection of the posterior segment of the eye. |
1 | 8,000.00 | 8,000.00 |
| 5 |
Prescription Medication Dispensing Supply of prescribed anti-inflammatory eye drops and lubricants as directed by the Ophthalmologist. |
1 | 12,000.00 | 12,000.00 |
| 6 |
Follow-up Administrative Fee Scheduling and record management for the next scheduled review in Khartoum. |
1 | 2,000.00 | 2,000.00 |
Payment Terms and Conditions
Currency: All amounts are quoted in Sudanese Pounds (SDG).
Due Date: Payment is due within 14 days of the Invoice date.
Payment Methods: Payments can be made via bank transfer to Khartoum Vision Care Center (Bank of Khartoum, Acc: 1234567890), cash at the reception desk, or via approved mobile payment services available in Sudan.
Late Fees: A late fee of 2% per month will be applied to overdue balances.
Disputes: Please contact our billing department within 7 days if you have any questions regarding this Invoice.
Medical Disclaimer: This Invoice represents the financial transaction for services rendered. It does not constitute a medical diagnosis or treatment plan. Please refer to your discharge summary or consultation notes provided by the Ophthalmologist for medical details.
Authorized Signature (Ophthalmologist)
Dr. Ahmed El-Tayeb
Patient Acknowledgement
Signature / Date
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