Invoice Physiotherapist in Brazil Rio de Janeiro –Free Word Template Download with AI
CNPJ: 12.345.678/0001-90
Address: Av. Atlântica, 1702 - Copacabana
Rio de Janeiro - RJ, 22021-001, Brazil
Phone: +55 (21) 3456-7890
Email: [email protected]
CRE: RJ-12345 (Physiotherapist License)
Invoice Number: INV-2024-0892
Date Issued: January 15, 2024
Due Date: January 30, 2024
Service Period: January 1-15, 2024
Status: Pending Payment
BILLING INFORMATIONClient Name: Maria Silva Santos
CPF: 123.456.789-00
Address: Rua das Laranjeiras, 456 - Laranjeiras
Rio de Janeiro - RJ, 22240-000, Brazil
Phone: +55 (21) 98765-4321
Email: [email protected]
Insurance: Blue Cross (Policy #BC-789456)
PHYSIOTHERAPY SERVICES RENDERED| Service Description | Procedure Code | Date | Quantity | Unit Price (BRL) | Total (BRL) |
|---|---|---|---|---|---|
| Manual Therapy for Lumbar Region - Initial Assessment and Treatment | 93295 | Jan 02, 2024 | 1 | R$ 250.00 | R$ 250.00 |
| Electrotherapy Session - TENS for Pain Management | 93010 | Jan 04, 2024 | 1 | R$ 120.00 | R$ 120.00 |
| Therapeutic Exercise Program - Core Strengthening | 97110 | Jan 06, 2024 | 1 | R$ 180.00 | R$ 180.00 |
| Postural Correction and Ergonomic Assessment | 97140 | Jan 09, 2024 | 1 | R$ 200.00 | R$ 200.00 |
| Soft Tissue Mobilization - Myofascial Release | 97140 | Jan 11, 2024 | 1 | R$ 160.00 | R$ 160.00 |
| Hydrotherapy Session - Aquatic Rehabilitation | 97035 | Jan 13, 2024 | 1 | R$ 220.00 | R$ 220.00 |
| Follow-up Evaluation and Treatment Plan Adjustment | 97161 | Jan 15, 2024 | 1 | R$ 150.00 | R$ 150.00 |
Accepted Payment Methods:
Bank Transfer (PIX): [email protected]
Bank Transfer (TED/DOC): Banco do Brasil, Agency: 1234-5, Account: 67890-1
Credit Card: Visa, Mastercard, Elo (up to 3 installments)
Debit Card: All major networks accepted
Cash: Accepted at our Rio de Janeiro clinic location
Important: Please include Invoice Number INV-2024-0892 as payment reference.
NOTES AND TERMS1. Service Description: This invoice covers physiotherapy services provided by licensed professionals at our Rio de Janeiro clinic. All treatments were performed in accordance with Brazilian physiotherapy standards and regulations established by the Federal Council of Physiotherapy and Occupational Therapy (COFFITO).
2. Payment Terms: Payment is due within 15 days from the invoice date. Late payments will incur a penalty of 2% plus interest of 1% per month, as per Brazilian commercial law.
3. Insurance Claims: For insurance reimbursement, please submit this invoice along with the detailed treatment report to your insurance provider. Our clinic can provide additional documentation if required by your insurance company.
4. Tax Information: This invoice is issued in compliance with Brazilian tax regulations. Services provided by physiotherapists in Rio de Janeiro are subject to specific tax treatments as defined by local legislation.
5. Patient Rights: As per Brazilian health regulations, you have the right to request copies of your medical records and treatment reports. Please contact our administrative office for any documentation requests.
Authorized Signature
Dr. Carlos Eduardo Mendes
Lead Physiotherapist
CRE-RJ: 12345
Client Acknowledgment
Maria Silva Santos
Date: _______________
This invoice is a legal document issued by Rio Physiotherapy Center, a registered healthcare provider in Rio de Janeiro, Brazil. All physiotherapy services are performed by licensed professionals registered with the Regional Council of Physiotherapy and Occupational Therapy of Rio de Janeiro (CREFITO-RJ). This document serves as proof of payment for healthcare services rendered and may be used for insurance claims, tax deductions, and medical records purposes. In case of any discrepancies or questions regarding this invoice, please contact our billing department within 30 days of the invoice date. Our clinic operates in full compliance with Brazilian health regulations, including Resolution COFFITO No. 464/2015 regarding physiotherapy practice standards.
Rio Physiotherapy Center | Av. Atlântica, 1702 - Copacabana | Rio de Janeiro - RJ, 22021-001 | Brazil | CNPJ: 12.345.678/0001-90
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