Invoice Orthodontist in Colombia Bogotá –Free Word Template Download with AI
Specialized Orthodontic Center
Carrera 7 # 72-21, Office 405
Chapinero, Bogotá D.C., Colombia
NIT: 900.123.456-7
Phone: +57 (1) 234 5678
Email: [email protected]
Invoice #: INV-2023-0892
Date: October 24, 2023
Due Date: November 24, 2023
Payment Terms: Net 30
Billed To:
Mr. Juan Carlos Pérez
ID (Cédula): 1.098.765.432
Address: Calle 100 # 15-30, Usaquén, Bogotá, Colombia
Email: [email protected]
Phone: +57 300 123 4567
| # | Description of Orthodontic Services | Code | Qty | Unit Price (COP) | Total (COP) |
|---|---|---|---|---|---|
| 1 | Initial Orthodontic Consultation and Diagnostic Evaluation in Bogotá Clinic | ORT-001 | 1 | 150,000 | 150,000 |
| 2 | Comprehensive Cephalometric and Panoramic X-Ray Analysis | RAD-002 | 1 | 200,000 | 200,000 |
| 3 | Custom Digital Impressions for Aligner Fabrication | LAB-003 | 1 | 350,000 | 350,000 |
| 4 | Full Series Clear Aligner Treatment Plan (18 Trays) | TRT-004 | 1 | 4,500,000 | 4,500,000 |
| 5 | Monthly Orthodontic Adjustment and Monitoring Visit | VIS-005 | 6 | 100,000 | 600,000 |
| 6 | Retention Phase: Custom Night Retainers (Upper and Lower) | RET-006 | 1 | 400,000 | 400,000 |
| Subtotal: | $6,200,000 COP |
| Discount (Early Payment): | -$200,000 COP |
| Taxable Base: | $6,000,000 COP |
| VAT (19% - IVA): | $1,140,000 COP |
| Grand Total: | $7,140,000 COP |
Payment Instructions:
Please make payments via bank transfer to the following account in Colombia:
Bank: Bancolombia
Account Type: Savings
Account Number: 123-456789-00
Reference: INV-2023-0892
For payments in Bogotá, cash or debit is accepted at our Chapinero office during business hours.
Terms, Conditions, and Legal Compliance:
This invoice is issued in accordance with the tax regulations established by the Dirección de Impuestos y Aduanas Nacionales (DIAN) of Colombia. The services rendered are provided by a licensed Orthodontist practicing within the jurisdiction of Bogotá D.C. All prices are quoted in Colombian Pesos (COP). The 19% Value Added Tax (IVA) is applied as per current national law for medical-dental services not exempted under specific health insurance plans.
The patient acknowledges that the orthodontic treatment plan is based on the clinical evaluation performed at our Bogotá facility. Results may vary based on patient compliance with wearing aligners or appliances as instructed. Regular follow-up appointments are mandatory to ensure the success of the orthodontic correction. Failure to attend scheduled visits may result in additional charges or discontinuation of treatment.
Data protection: Personal information collected in this invoice is handled in compliance with Law 1581 of 2012 (Habeas Data) of Colombia. It will be used solely for billing, medical records, and legal compliance purposes. This document serves as a valid proof of payment and medical service receipt for insurance reimbursement claims in Colombia.
Thank you for choosing Smile Align Orthodontics for your dental health needs in Bogotá.
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