Invoice Psychiatrist in Argentina Buenos Aires –Free Word Template Download with AI
Specialist Psychiatrist
Matrícula: MP 12345 - MPA 67890
Av. Santa Fe 1850, Piso 4, Of. 402
C1425BGH CABA, Buenos Aires, Argentina
Tel: +54 11 4823-5678
Email: [email protected]
CUIT: 20-12345678-9
Invoice Number: INV-2024-0892
Date Issued: October 15, 2024
Due Date: October 30, 2024
Currency: Argentine Peso (ARS)
Bill ToMaría Elena Fernández López
DNI: 28.456.789
Av. Córdoba 2100, Depto 5B
C1054AAZ CABA, Buenos Aires, Argentina
Email: [email protected]
Tel: +54 11 4555-1234
Service Period & ReferenceService Period: September 1, 2024 - September 30, 2024
Patient Name: María Elena Fernández López
Diagnosis Code (CIE-10): F41.1 (Generalized Anxiety Disorder)
Treatment Plan Reference: TP-2024-0456
Insurance Provider: OSDE (Policy #987654321)
Authorization Code: AUT-BA-2024-7890
| # | Description of Services | Date | Qty | Unit Price (ARS) | Total (ARS) |
|---|---|---|---|---|---|
| 1 | Initial Psychiatric Consultation and Comprehensive Diagnostic Evaluation including clinical history, mental status examination, and risk assessment. | 2024-09-03 | 1 | 45,000.00 | 45,000.00 |
| 2 | Follow-up Psychiatric Session (45 minutes) - Medication management and therapeutic monitoring for anxiety disorder treatment. | 2024-09-10 | 1 | 35,000.00 | 35,000.00 |
| 3 | Follow-up Psychiatric Session (45 minutes) - Cognitive-behavioral strategies implementation and symptom evaluation. | 2024-09-17 | 1 | 35,000.00 | 35,000.00 |
| 4 | Follow-up Psychiatric Session (45 minutes) - Treatment adjustment and psychoeducation regarding medication adherence. | 2024-09-24 | 1 | 35,000.00 | 35,000.00 |
| 5 | Psychiatric Report for Insurance/Workplace - Detailed clinical summary including diagnosis, treatment plan, and prognosis for OSDE authorization. | 2024-09-28 | 1 | 25,000.00 | 25,000.00 |
| 6 | Emergency Psychiatric Consultation (after-hours) - Acute anxiety episode management and crisis intervention. | 2024-09-15 | 1 | 55,000.00 | 55,000.00 |
Bank Transfer (Transferencia Bancaria):
Bank: Banco Galicia
CBU: 0070000000000000123456
Alias: PSIQUIATRIA.ROSSI.ALEJANDRO
Account Holder: Dr. Alejandro M. Rossi
Reference: Please include Invoice Number INV-2024-0892 in the transfer reference.
Payment Deadline: October 30, 2024. Late payments may incur a 2% monthly interest charge as per Argentine commercial law.
Important Notes & Terms
1. This invoice is issued in accordance with the regulations of the Argentine Federal Administration of Public Revenue (AFIP) and the Buenos Aires City Government.
2. All psychiatric services rendered comply with the ethical standards established by the Buenos Aires College of Psychiatrists (Colegio de Psiquiatras de Buenos Aires).
3. Patient confidentiality is maintained in strict accordance with Argentine Law 25.326 on Personal Data Protection and medical ethics codes.
4. This invoice is valid for reimbursement purposes with Argentine health insurance providers (Obras Sociales and Prepagas) including OSDE, Swiss Medical, Galeno, and others.
5. Services were provided at our clinic located in the Recoleta neighborhood of Buenos Aires, Argentina, a premier medical district known for specialized psychiatric care.
6. In case of any discrepancies with this invoice, please contact our administrative office within 15 business days of receipt.
7. This document serves as official proof of payment for medical services rendered by a licensed psychiatrist practicing in the Autonomous City of Buenos Aires (CABA).
8. All prices are quoted in Argentine Pesos (ARS) and are subject to current tax regulations applicable in Argentina as of the date of service.
Authorized Signature
Dr. Alejandro M. Rossi
Specialist Psychiatrist
MP 12345 - MPA 67890
Received By
Date: _______________
Signature: _______________
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