Invoice Physiotherapist in Ivory Coast Abidjan –Free Word Template Download with AI
Specialized Rehabilitation & Sports Medicine
123 Boulevard de la République, Cocody
Abidjan, Ivory Coast
Tel: +225 27 22 44 55 66
Email: [email protected]
RC: ABJ-2023-4599 | NINEA: 000-123456789
Invoice #: INV-2023-10-045
Date: October 24, 2023
Due Date: November 07, 2023
Reference: Patient ID #PT-8892
Billed To:
Monsieur Jean-Marc Kouassi
45 Rue des Jardins, Marcory
Abidjan, Ivory Coast
Phone: +225 07 08 09 10 11
Insurance Provider: CIAM (Caisse Ivoirienne d'Assurance Maladie)
Policy Number: CIAM-99887766
| Description of Services | Code | Qty | Unit Price (XOF) | Total (XOF) |
|---|---|---|---|---|
|
Initial Comprehensive Physiotherapy Assessment Detailed evaluation of musculoskeletal condition, range of motion testing, and functional analysis conducted at our Abidjan clinic. |
PT-INIT | 1 | 25,000 | 25,000 |
|
Manual Therapy Session (Lumbar Region) Soft tissue mobilization and joint manipulation to alleviate lower back pain and improve mobility. |
PT-MAN | 4 | 15,000 | 60,000 |
|
Therapeutic Exercise Program Supervised strengthening and flexibility exercises tailored for post-injury recovery. |
PT-EXER | 4 | 12,000 | 48,000 |
|
Electrotherapy (TENS/Interferential) Pain management using electrical stimulation modalities. |
PT-ELEC | 4 | 8,000 | 32,000 |
|
Ultrasound Therapy Deep heat therapy to promote tissue healing and reduce inflammation. |
PT-US | 2 | 10,000 | 20,000 |
|
Postural Correction Consultation Ergonomic advice and postural re-education for office workers in Abidjan. |
PT-POST | 1 | 15,000 | 15,000 |
Payment Instructions & Terms
This invoice is issued in accordance with the healthcare regulations of the Republic of Ivory Coast. Payment is due within 14 days of the invoice date. Please make payments in West African CFA Francs (XOF).
Bank Transfer Details:
Bank: Ecobank Côte d'Ivoire
Account Name: Abidjan Elite Physiotherapy Center
Account Number: 1234567890123
SWIFT Code: ECOBCICJ
Reference: INV-2023-10-045
Mobile Money:
Orange Money / MTN MoMo: +225 07 08 09 10 11
Important Notes for the Patient:
1. This document serves as an official receipt for your physiotherapy treatments received in Abidjan.
2. Please retain this invoice for your personal records and for submission to your insurance provider if required.
3. If you have any questions regarding the charges or your treatment plan, please contact our billing department.
4. Late payments may incur a penalty fee of 5% after 30 days.
5. Our physiotherapists are licensed by the Ordre National des Médecins de Côte d'Ivoire.
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