Invoice Orthodontist in Colombia Medellín –Free Word Template Download with AI
Clinica Odontológica Especializada
Carrera 43A # 12-34, El Poblado
Medellín, Antioquia, Colombia
NIT: 900.123.456-7
Phone: +57 (4) 444-5555
Email: [email protected]
Invoice Number: INV-2024-0892
Date Issued: October 15, 2024
Due Date: October 30, 2024
Payment Terms: Net 15 Days
From (Provider)
Dr. Alejandro Restrepo, M.D., Orthodontist
License No. 12345678
Medellín Orthodontic Excellence
Carrera 43A # 12-34, El Poblado
Medellín, Antioquia, Colombia
NIT: 900.123.456-7
Bill To (Patient)
María Fernanda Gómez López
ID (Cédula): 1.098.765.432
Calle 9 # 32-15, Apt 302
Laureles, Medellín, Antioquia
Colombia
Email: [email protected]
Phone: +57 300 123 4567
| # | Description of Orthodontic Services | Quantity | Unit Price (COP) | Total (COP) | Tax Code |
|---|---|---|---|---|---|
| 1 |
Initial Orthodontic Consultation & Diagnostic Evaluation Comprehensive clinical examination, panoramic radiograph, cephalometric analysis, and digital intraoral scanning for treatment planning. Includes discussion of orthodontic options and personalized treatment proposal. |
1 | 350,000 | 350,000 | Exempt |
| 2 |
Fixed Orthodontic Appliance Installation (Metal Brackets) Professional placement of high-quality stainless steel orthodontic brackets on both upper and lower arches. Includes bonding procedure, archwire insertion, and initial adjustment. This service is part of the comprehensive orthodontic treatment plan. |
1 | 4,500,000 | 4,500,000 | Exempt |
| 3 |
Orthodontic Adjustment & Progress Monitoring (Monthly Visit) Routine adjustment appointment including wire changes, ligature replacement, and progress assessment. Ensures optimal tooth movement and treatment efficiency. Includes oral hygiene instruction and appliance care guidance. |
3 | 180,000 | 540,000 | Exempt |
| 4 |
Intermaxillary Elastics & Auxiliaries Provision of orthodontic elastics, power chains, and auxiliary components required for bite correction and alignment refinement. Materials are replaced as needed during treatment progress. |
1 | 250,000 | 250,000 | Exempt |
| 5 |
Emergency Orthodontic Visit Unscheduled appointment for appliance repair, including bracket rebonding and wire adjustment due to accidental damage. Includes clinical evaluation and necessary corrective measures. |
1 | 150,000 | 150,000 | Exempt |
| 6 |
Professional Dental Cleaning (Prophylaxis) Comprehensive supragingival and subgingival cleaning performed by certified dental hygienist. Includes scaling, polishing, and fluoride application to maintain oral health during orthodontic treatment. |
1 | 200,000 | 200,000 | Exempt |
| 7 |
Orthodontic Retainer (Hawley Type) Custom-fabricated removable retainer for post-treatment retention. Includes initial fitting, adjustments, and patient education on proper use and maintenance. |
1 | 450,000 | 450,000 | Exempt |
| 8 |
Final Records & Documentation Post-treatment documentation including final photographs, radiographs, and study models. Includes comprehensive treatment summary and discharge instructions. |
1 | 180,000 | 180,000 | Exempt |
| Subtotal (Services) | 6,620,000 COP |
| Discount (Early Payment) | -150,000 COP |
| Adjustable VAT (IVA 19%) - Medical Services | 0 COP |
| TOTAL AMOUNT DUE | 6,470,000 COP |
Payment Instructions & Important Notes
Currency: All amounts are expressed in Colombian Pesos (COP).
Bank Transfer Details:
Bank: Bancolombia
Account Type: Savings Account (Cuenta de Ahorros)
Account Number: 123-456789-00
Account Holder: Medellín Orthodontic Excellence S.A.S.
NIT: 900.123.456-7
Payment Reference: Please include Invoice Number INV-2024-0892 and Patient Name when making payment.
Tax Information: According to Colombian tax regulations (Estatuto Tributario), orthodontic services provided by licensed professionals are exempt from Value Added Tax (IVA). This invoice complies with the requirements of the Dirección de Impuestos y Aduanas Nacionales (DIAN).
Payment Methods Accepted: Bank transfer, cash, credit/debit cards (Visa, Mastercard, American Express), and PSE (Pagos Seguros en Línea).
Late Payment Policy: Payments received after the due date may be subject to a late fee of 2% per month on the outstanding balance, in accordance with Colombian commercial law.
Invoice Validity: This invoice is valid for 30 days from the date of issuance. Please contact our billing department if you have any questions or require additional documentation.
Medical Disclaimer: This invoice represents payment for orthodontic services rendered. Treatment outcomes may vary based on individual patient compliance and biological response. Regular attendance at scheduled appointments is essential for successful treatment completion.
Authorized Signature (Provider)
Dr. Alejandro Restrepo, M.D.
Orthodontist - License No. 12345678
Medellín Orthodontic Excellence
Received By (Patient)
María Fernanda Gómez López
ID: 1.098.765.432
Date: _______________
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