Invoice Ophthalmologist in Vietnam Ho Chi Minh City –Free Word Template Download with AI

Bill To:

Mr. Nguyen Van A

45 Le Loi Street, District 3

Ho Chi Minh City, Vietnam

ID/Passport: 079087654321

Insurance Provider: Vinamcare Insurance JSC

Policy Number: VC-99887766

#	Description of Ophthalmological Services	Quantity	Unit Price (VND)	Total (VND)
1	Comprehensive Ophthalmological Examination Includes visual acuity testing, refraction, slit-lamp examination, and intraocular pressure measurement performed by a senior Ophthalmologist in Ho Chi Minh City.	1	1,500,000	1,500,000
2	Dilated Fundus Examination Detailed retinal assessment using mydriatic drops to evaluate the optic nerve and retina for signs of diabetic retinopathy or glaucoma.	1	800,000	800,000
3	Optical Coherence Tomography (OCT) Advanced imaging scan of the retina to detect macular degeneration and other structural abnormalities.	1	1,200,000	1,200,000
4	Prescription Eyewear Consultation Analysis of prescription requirements and fitting for corrective lenses tailored to the patient's specific visual needs.	1	500,000	500,000
5	Specialized Glaucoma Screening Perimetry (visual field test) and corneal pachymetry conducted at our Ho Chi Minh City clinic.	1	1,000,000	1,000,000

Subtotal: 5,000,000 VND VAT (10%): 500,000 VND Insurance Deductible: (500,000 VND) TOTAL DUE: 5,000,000 VND

Terms and Conditions for Ophthalmology Services in Vietnam

This invoice represents the professional fees for medical services rendered by a licensed Ophthalmologist at Saigon Vision Specialists, located in Ho Chi Minh City, Vietnam. All services were performed in accordance with the medical standards set by the Ministry of Health of Vietnam.

Payment Instructions: Payment is due within 30 days of the invoice date. Please make bank transfers to our account at Vietcombank, Account Name: Saigon Vision Specialists, Account Number: 0071001234567, SWIFT Code: BFTVVNVX. Please reference the Invoice Number (INV-2023-10-045) in your payment description.

Medical Disclaimer: The charges listed above cover the diagnostic and consultation services provided. Any surgical procedures, such as LASIK or cataract surgery, will require a separate consultation and a distinct invoice. This document serves as an official receipt for tax and insurance reimbursement purposes within Vietnam.

Privacy Policy: In compliance with Vietnamese law regarding personal data protection, your medical records and financial information are kept strictly confidential. This invoice contains sensitive personal data and should be handled securely.

Thank you for choosing our Ophthalmology department in Ho Chi Minh City for your eye care needs. We are committed to providing the highest quality vision care services to our patients in this region.

Authorized Signature

Dr. Tran Thi B

Chief Ophthalmologist

Received By

Date: _______________

Signature: _______________

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