Invoice Ophthalmologist in Tanzania Dar es Salaam –Free Word Template Download with AI
Specialized Ophthalmology Clinic
Plot No. 45, Ali Hassan Mwinyi Road
Mikocheni Area, Dar es Salaam
United Republic of Tanzania
Tel: +255 22 211 5500 | Email: [email protected]
TIN: 123-456-789-00-00-000
Invoice Number: INV-2023-10-089
Date of Issue: October 24, 2023
Due Date: November 07, 2023
Payment Terms: Net 14 Days
Bill To:
Patient Name: John Doe
Address: P.O. Box 7890, Kariakoo, Dar es Salaam, Tanzania
Phone: +255 755 123 456
Insurance Provider: AAR Insurance (Policy #AAR-998877)
| # | Description of Ophthalmological Services | Date of Service | Quantity | Amount (TZS) |
|---|---|---|---|---|
| 1 |
Comprehensive Ophthalmic Examination Includes visual acuity testing, refraction, slit-lamp biomicroscopy, and tonometry. Performed by a certified Ophthalmologist in Dar es Salaam. |
Oct 24, 2023 | 1 | 150,000 |
| 2 |
Dilated Fundus Examination Detailed inspection of the retina, optic nerve, and macula using mydriatic drops. Essential for diagnosing diabetic retinopathy and glaucoma. |
Oct 24, 2023 | 1 | 75,000 |
| 3 |
Optical Coherence Tomography (OCT) Advanced imaging of the retinal layers to assess macular health and nerve fiber layer thickness. |
Oct 24, 2023 | 1 | 200,000 |
| 4 |
Prescription Eyewear Dispensing High-index anti-reflective lenses with frame fitting. |
Oct 24, 2023 | 1 | 350,000 |
| 5 |
Consultation Fee (Specialist) Professional fee for the attending Ophthalmologist for diagnosis and treatment planning. |
Oct 24, 2023 | 1 | 100,000 |
Payment Instructions
Please remit payment in Tanzanian Shillings (TZS) via one of the following methods:
- Bank Transfer: CRDB Bank, Branch: Mikocheni. Account Name: Dar es Salaam Vision Care Center Ltd. Account No: 0123456789.
- M-Pesa / Tigo Pesa: +255 712 345 678 (Business Line).
- Cash: Accepted at the clinic reception during business hours (Mon-Sat, 8:00 AM - 5:00 PM).
Note: Please reference Invoice Number INV-2023-10-089 in your payment description.
Important Notes & Terms
This invoice represents the professional fees and services rendered by our team of qualified Ophthalmologists at Dar es Salaam Vision Care Center. All medical procedures were conducted in accordance with the standards set by the Medical and Dental Practitioners Council of Tanzania (MDPCT). The charges listed above are inclusive of all necessary diagnostic tests and materials used during your visit.
Payment is due within 14 days of the invoice date. Late payments may incur a penalty fee of 2% per month. If you have any questions regarding this invoice or your treatment plan, please contact our billing department immediately. We are committed to providing transparent and high-quality eye care services to the residents of Dar es Salaam and the wider Tanzania region.
Disclaimer: This document is a financial record and does not constitute a medical report. For detailed clinical findings, please request a separate medical summary from your treating physician.
Authorized By:
Dr. Amina Juma, MBChB, FCOphth
Lead Ophthalmologist
Signature:
Received By:
Patient / Guarantor
Signature:
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