Invoice Orthodontist in Argentina Córdoba –Free Word Template Download with AI
Matrícula: M.P. 12345 / M.P.C. 6789
Address: Av. Colón 500, Piso 3, Of. 3B
City: Córdoba Capital, Córdoba, Argentina
Phone: +54 351 456-7890
Email: [email protected]
CUIT: 20-12345678-9
Invoice Number: #INV-2023-0892
Date of Issue: October 24, 2023
Due Date: November 07, 2023
Payment Terms: Net 14 Days
Bill To:
Patient Name: Maria Elena Gonzalez
DNI: 25.678.901
Address: Calle San Jerónimo 1234, Barrio Nueva Córdoba
City: Córdoba, Argentina
Phone: +54 351 123-4567
Email: [email protected]
Insurance Provider: OSDE (Policy #987654321)
| # | Description of Orthodontic Services | Code | Qty | Unit Price (ARS) | Total (ARS) |
|---|---|---|---|---|---|
| 1 | Initial Orthodontic Consultation and Diagnostic Evaluation in Córdoba Clinic | ORT-001 | 1 | 15,000.00 | 15,000.00 |
| 2 | Full Set of Orthodontic X-Rays (Panoramic and Cephalometric) | RAD-005 | 1 | 12,500.00 | 12,500.00 |
| 3 | Digital Impressions and 3D Treatment Planning | DIG-010 | 1 | 18,000.00 | 18,000.00 |
| 4 | Placement of Fixed Metal Braces (Upper and Lower Arch) | BRZ-100 | 1 | 120,000.00 | 120,000.00 |
| 5 | First Month Adjustment and Activation Session | ADJ-001 | 1 | 8,500.00 | 8,500.00 |
| 6 | Orthodontic Elastics and Ligatures Supply (3-month pack) | ACC-020 | 1 | 4,500.00 | 4,500.00 |
| 7 | Emergency Visit for Bracket Repair (October 2023) | EMG-005 | 1 | 6,000.00 | 6,000.00 |
| Subtotal: | ARS 184,500.00 |
| IVA (21%): | ARS 38,745.00 |
| Insurance Coverage (OSDE): | - ARS 45,000.00 |
| Total Due: | ARS 178,245.00 |
Payment Instructions:
Please make payment within 14 days of the invoice date. Payments can be made via bank transfer or credit card at our clinic in Córdoba.
Bank Details:
Bank: Banco Galicia
Account Name: Dr. Alejandro Rossi
CBU: 0070001234567890123456
Reference: Invoice #INV-2023-0892
Credit Card: Visa, Mastercard, and American Express accepted. Installment plans available for treatments exceeding ARS 100,000.
Terms and Conditions:
1. This invoice is issued in accordance with the tax regulations of Argentina and the professional standards of the Córdoba Dental Association.
2. All orthodontic treatments are subject to a comprehensive treatment plan agreed upon by the patient and the orthodontist.
3. Missed appointments without 24-hour notice may incur a fee of ARS 5,000.
4. The total treatment cost may vary based on individual patient needs and unforeseen complications.
5. Insurance coverage is estimated and subject to verification by the respective provider.
6. Late payments may incur a monthly interest rate of 3% as per Argentine commercial law.
7. This invoice serves as an official receipt for tax purposes in Argentina.
8. For any questions regarding this invoice, please contact our administrative office in Córdoba during business hours (Monday to Friday, 9:00 AM - 6:00 PM).
Authorized Signature
Dr. Alejandro Rossi
Orthodontist
Patient Signature
Maria Elena Gonzalez
Date: _______________
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