Invoice Ophthalmologist in Switzerland Zurich –Free Word Template Download with AI
Dr. med. Elena Müller, FMH Ophthalmology
Bahnhofstrasse 45, 8001 Zurich, Switzerland
Tel: +41 44 123 45 67 | Email: [email protected]
VAT ID: CHE-123.456.789 MWST
INVOICE
Bill To (Patient)Mr. Hans Weber
Rämistrasse 101
8006 Zurich, Switzerland
AVS/AHV No: 756.1234.5678.95
Insurance ProviderSwiss Life Assurance Company
Policy No: SL-9988776655
Group No: ZRH-CORP-001
Reference: Ophthalmology Consultation
Description of Ophthalmological Services| Code | Service Description | Qty | Unit Price (CHF) | Total (CHF) |
|---|---|---|---|---|
| 20010 |
Comprehensive Ophthalmological Examination Detailed consultation regarding visual acuity complaints. Includes history taking, slit-lamp biomicroscopy of the anterior segment, and assessment of ocular motility. Performed in accordance with FMH guidelines for ophthalmology in Zurich. |
1 | 180.00 | 180.00 |
| 20020 |
Dilated Fundus Examination Pharmacological mydriasis (pupil dilation) followed by indirect ophthalmoscopy to evaluate the retina, macula, and optic nerve head. Essential for ruling out retinal detachment or diabetic retinopathy. |
1 | 120.00 | 120.00 |
| 20030 |
Optical Coherence Tomography (OCT) High-resolution cross-sectional imaging of the retina. Used to assess macular thickness and detect early signs of glaucoma or macular degeneration. Includes analysis and interpretation by the attending ophthalmologist. |
1 | 250.00 | 250.00 |
| 20040 |
Visual Field Test (Perimetry) Automated static perimetry (Humphrey Field Analyzer) to map the peripheral vision. Critical for monitoring glaucoma progression and neurological visual field defects. |
1 | 150.00 | 150.00 |
| 20050 |
Intraocular Pressure Measurement Goldmann applanation tonometry to measure eye pressure. Standard procedure for glaucoma screening and management within the Zurich Vision Institute protocol. |
1 | 60.00 | 60.00 |
| 20060 |
Refraction and Prescription Update Subjective and objective refraction to determine precise corrective lens requirements. Includes prescription for glasses or contact lenses. |
1 | 90.00 | 90.00 |
| 20070 |
Corneal Topography Mapping of the corneal surface curvature. Utilized for contact lens fitting and pre-operative assessment for refractive surgery candidates. |
1 | 140.00 | 140.00 |
Payment Instructions
Please remit payment within 30 days of the invoice date. Payments can be made via bank transfer to the following account:
Bank: UBS Switzerland AG
IBAN: CH93 0076 2011 6238 5295 7
BIC: UBSWCHZH80A
Reference: ZVI-2023-10-892 / Hans Weber
Important Information Regarding Ophthalmology Services in Zurich
This invoice reflects the standard fee schedule for specialized ophthalmological care in Zurich, Switzerland. As a member of the Swiss Medical Association (FMH), Dr. Müller adheres to the highest standards of clinical practice. The services listed above are covered under the Swiss Federal Health Insurance Act (KVG/LAMal) up to the limits defined by your specific insurance policy.
Please note that while basic ophthalmological examinations are mandatory benefits, advanced diagnostic imaging such as OCT and Corneal Topography may be subject to your insurance plan's specific coverage terms or may require a co-payment (franchise). If this invoice is being submitted for reimbursement, please ensure you attach this document along with any required medical reports to your insurance provider.
For any questions regarding this invoice or your ophthalmological treatment plan, please contact our billing department in Zurich directly. We are committed to providing transparent and accurate billing for all our patients.
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