Invoice Physiotherapist in United States Houston –Free Word Template Download with AI
1200 Main Street, Suite 400
Houston, Texas 77002
United States
Phone: (713) 555-0199
Email: [email protected]
TIN: 74-1234567
Invoice Number: INV-2023-8942
Date Issued: October 24, 2023
Due Date: November 24, 2023
Bill To:
Patient Name: John Doe
Address: 456 Westheimer Road, Apt 3B
Houston, Texas 77027
United States
Insurance Provider: Blue Cross Blue Shield of Texas
Policy Number: BCBS-TX-99887766
Group Number: GRP-554433
| Description of Services | Code | Date | Qty | Unit Price | Amount |
|---|---|---|---|---|---|
|
Initial Evaluation Comprehensive assessment of musculoskeletal condition. Includes history taking, physical examination, and development of a treatment plan tailored to the patient's specific needs within the Houston healthcare system. |
97161 | Oct 10, 2023 | 1 | $150.00 | $150.00 |
|
Therapeutic Exercise Supervised exercise program designed to improve strength, flexibility, and endurance. Focus on core stabilization and lower extremity mechanics. |
97110 | Oct 12, 2023 | 1 | $65.00 | $65.00 |
|
Manual Therapy Hands-on techniques to mobilize joints and soft tissues to reduce pain and improve function. Includes myofascial release and joint mobilization. |
97140 | Oct 12, 2023 | 1 | $75.00 | $75.00 |
|
Therapeutic Exercise Continued supervised exercise program focusing on gait training and balance re-education. |
97110 | Oct 17, 2023 | 1 | $65.00 | $65.00 |
|
Manual Therapy Advanced manual techniques targeting lumbar spine and hip region to alleviate referred pain. |
97140 | Oct 17, 2023 | 1 | $75.00 | $75.00 |
|
Ultrasound Therapy Application of therapeutic ultrasound to promote tissue healing and reduce inflammation in the affected area. |
97035 | Oct 19, 2023 | 1 | $45.00 | $45.00 |
|
Therapeutic Exercise Progression of exercise intensity and complexity based on patient improvement. |
97110 | Oct 19, 2023 | 1 | $65.00 | $65.00 |
|
Re-evaluation Assessment of progress towards goals and modification of the treatment plan as necessary. |
97162 | Oct 24, 2023 | 1 | $120.00 | $120.00 |
Terms and Conditions:
This Invoice represents the charges for physiotherapy services rendered by Houston Elite Physiotherapy, a licensed provider operating in Houston, Texas, United States. All services were performed by a certified and licensed Physiotherapist in accordance with the standards set by the Texas State Board of Physical Therapy Examiners.
Payment is due within 30 days of the invoice date. Please make checks payable to "Houston Elite Physiotherapy" and mail to the address listed above. We also accept major credit cards and electronic payments. Late payments may be subject to a 1.5% monthly finance charge.
Insurance information provided is for billing purposes only. It is the patient's responsibility to verify their coverage and benefits with their insurance provider. This invoice reflects the estimated patient responsibility after insurance adjustments. Final amounts may vary based on actual insurance reimbursement.
If you have any questions regarding this invoice or the services provided, please contact our billing department at (713) 555-0199 or email [email protected]. We are committed to providing clear and transparent billing practices to all our patients in the Houston community.
Thank you for choosing Houston Elite Physiotherapy for your rehabilitation needs. We are dedicated to helping you achieve optimal health and mobility through evidence-based physiotherapy practices.
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