Invoice Ophthalmologist in Uganda Kampala –Free Word Template Download with AI

Bill To:

Mrs. Sarah Nakato

House 12, Bukoto Street

Kampala, Uganda

Phone: +256 772 987 654

Patient ID: KVS-2024-0892

Invoice Number:	KVS-INV-2024-1547
Date of Issue:	November 15, 2024
Due Date:	November 30, 2024
Service Date:	November 14, 2024
Attending Ophthalmologist:	Dr. James Okello, MBChB, FCOphth(UK)

Description of Ophthalmological Services Rendered

The following invoice details comprehensive eye care services provided by our certified ophthalmologist team at our Kampala, Uganda facility. All procedures were conducted in accordance with the Uganda Medical and Dental Practitioners Council standards and international ophthalmology best practices.

#	Service Description	Quantity	Unit Price (UGX)	Total (UGX)
1	Comprehensive Ophthalmological Examination Complete eye health assessment including medical history review, visual acuity testing, slit-lamp examination, and intraocular pressure measurement performed by qualified ophthalmologist.	1	150,000	150,000
2	Dilated Fundus Examination Pupil dilation with tropicamide and phenylephrine drops, followed by detailed retinal examination to assess for diabetic retinopathy, glaucoma, and macular degeneration.	1	75,000	75,000
3	Optical Coherence Tomography (OCT) Scan Advanced imaging of retinal layers for precise diagnosis of macular conditions and optic nerve assessment using state-of-the-art equipment available at our Kampala clinic.	1	250,000	250,000
4	Visual Field Test (Perimetry) Automated perimetry to map peripheral vision and detect glaucomatous damage or neurological visual field defects.	1	120,000	120,000
5	Prescription Eyeglasses - Single Vision Lenses High-quality anti-reflective coated lenses with durable frame, dispensed by our in-house optometry team following ophthalmologist prescription.	1	350,000	350,000
6	Prescription Medication - Lubricating Eye Drops Artificial tears (Sodium Hyaluronate 0.1%) - 2 bottles for dry eye syndrome management as prescribed by attending ophthalmologist.	2	45,000	90,000
7	Follow-up Consultation Fee Scheduled review appointment with ophthalmologist to assess treatment progress and adjust management plan as necessary.	1	100,000	100,000

Subtotal:	1,135,000
VAT (18% - Uganda Revenue Authority Compliant):	204,300
Insurance Adjustment (NSSF/Mutual Health):	(200,000)
GRAND TOTAL DUE:	1,139,300 UGX

Payment Instructions - Kampala, Uganda

Amount Due: UGX 1,139,300 (One Million One Hundred Thirty-Nine Thousand Three Hundred Uganda Shillings)

Payment Deadline: November 30, 2024

Accepted Payment Methods:

• Mobile Money: MTN MoMo / Airtel Money - +256 772 123 456 (Kampala Vision Specialists)

• Bank Transfer: Stanbic Bank Uganda Ltd, Kampala Branch

Account Name: Kampala Vision Specialists Ltd

Account Number: 1001234567890

Sort Code: 010

• Cash Payment: Accepted at our Kampala clinic reception during business hours

Reference: Please include Invoice Number KVS-INV-2024-1547 with all payments

Important Notes & Terms:

1. This invoice is issued by Kampala Vision Specialists, a registered ophthalmology practice in Kampala, Uganda, providing comprehensive eye care services under the supervision of qualified ophthalmologists.

2. Payment is due within 15 days of the invoice date. Late payments may incur a 2% monthly interest charge as per Uganda's standard medical billing practices.

3. All ophthalmological services rendered comply with the standards set by the Uganda Medical and Dental Practitioners Council (UMDPC) and the Uganda Eye Society.

4. Insurance claims should be submitted directly to your provider with this invoice as supporting documentation. Our billing department can assist with insurance processing in Kampala.

5. Please retain this invoice for your records and for any future medical reference regarding your ophthalmological treatment.

6. For any questions regarding this invoice or your eye care treatment, please contact our billing department at +256 414 123 456 or visit our Kampala clinic.

7. This document serves as an official receipt upon payment confirmation and is valid for tax purposes in Uganda.

Authorized Signature:

Dr. James Okello
Lead Ophthalmologist
Kampala Vision Specialists

Patient Acknowledgment:

Patient Signature
Date

Kampala Vision Specialists | Professional Ophthalmology Services in Kampala, Uganda | Registered with Uganda Medical and Dental Practitioners Council | TIN: UG-123456789 | This invoice is computer-generated and valid without physical stamp

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