Invoice Physiotherapist in Indonesia Jakarta –Free Word Template Download with AI
Professional Physiotherapy & Rehabilitation Center
Jl. Sudirman Kav. 52-53, SCBD Lot 9, Level 2
Kebayoran Baru, South Jakarta, DKI Jakarta 12190
Indonesia
Telp: +62 21 5799 8800 | Email: [email protected]
NPWP: 01.234.567.8-901.000
Invoice Number: INV-JKT-2023-0894
Date of Issue: October 24, 2023
Due Date: November 07, 2023
Payment Status: Unpaid
Billed To (Patient / Insurance)
Mr. Budi Santoso
PT. Global Tech Solutions Indonesia
Jl. Gatot Subroto Kav. 37
Setiabudi, Central Jakarta, DKI Jakarta 12950
Indonesia
Phone: +62 812 3456 7890
BPJS Kesehatan ID: 1234567890123456
Service Location
PT. Jakarta Rehabilitasi Medika
Outpatient Physiotherapy Clinic
Jl. Sudirman Kav. 52-53, SCBD Lot 9
Kebayoran Baru, South Jakarta, DKI Jakarta 12190
Indonesia
Note: All physiotherapy sessions were conducted at this facility in Jakarta.
| No. | Description of Physiotherapy Services | Date | Qty | Unit Price (IDR) | Total (IDR) |
|---|---|---|---|---|---|
| 1 |
Initial Physiotherapy Assessment & Diagnosis Comprehensive evaluation of musculoskeletal condition, range of motion testing, and treatment plan formulation by licensed Physiotherapist. |
Oct 10 | 1 | 750,000 | 750,000 |
| 2 |
Manual Therapy Session (Lumbar Spine) Hands-on treatment including soft tissue mobilization, joint manipulation, and myofascial release to alleviate lower back pain. |
Oct 12 | 1 | 500,000 | 500,000 |
| 3 |
Therapeutic Exercise Program Guided core strengthening and flexibility exercises tailored for post-injury rehabilitation. |
Oct 14 | 1 | 450,000 | 450,000 |
| 4 |
Electrotherapy (TENS & Ultrasound) Application of electrical stimulation and therapeutic ultrasound to reduce inflammation and promote tissue healing. |
Oct 16 | 1 | 350,000 | 350,000 |
| 5 |
Manual Therapy Session (Cervical Spine) Targeted treatment for neck stiffness and tension headaches. |
Oct 18 | 1 | 500,000 | 500,000 |
| 6 |
Progress Evaluation & Home Exercise Plan Review of treatment progress and provision of a customized home exercise regimen. |
Oct 20 | 1 | 400,000 | 400,000 |
Amount in words: Two Million Nine Hundred Thirty-Nine Thousand Four Hundred Fifty Indonesian Rupiah.
Payment Instructions
Please remit payment within 14 days of the invoice date to avoid late fees. Payments can be made via bank transfer to the following account:
Bank: Bank Central Asia (BCA)
Account Name: PT. Jakarta Rehabilitasi Medika
Account Number: 123-456-7890
Branch: Jakarta SCBD
For insurance claims, please submit this invoice along with the medical report to your respective insurance provider. We accept major insurance providers operating in Indonesia Jakarta.
Terms and Conditions
1. This invoice is issued in accordance with the regulations of the Ministry of Health of the Republic of Indonesia.
2. All physiotherapy services were performed by licensed Physiotherapists registered with the Indonesian Physiotherapy Association (IPI).
3. Late payments will incur a penalty of 2% per month on the outstanding balance.
4. Any disputes regarding this invoice must be raised within 30 days of the issue date.
5. This document serves as an official receipt for tax purposes in Indonesia.
Issued By:
Dr. Sarah Wijaya, PT, M.Sc.Senior Physiotherapist
PT. Jakarta Rehabilitasi Medika
Received By:
__________________________Name & Signature
Date ⬇️ Download as DOCX Edit online as DOCX
Create your own Word template with our GoGPT AI prompt:
GoGPT