Invoice Psychiatrist in Belgium Brussels –Free Word Template Download with AI
Member of the Royal Belgian Medical Association
INVOICE
Invoice Number: INV-2023-10-045
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Bill To:
Mr. Jean-Pierre Dubois
12 Rue de la Loi
1040 Brussels, Belgium
National Registry Number (RIZIV/INAMI): 9876543210
From:
Dr. Elena Vandenberghe
Private Practice - Psychiatry & Psychotherapy
45 Avenue Louise
1050 Brussels, Belgium
VAT Number: BE0678.901.234
Phone: +32 2 555 0199
Email: [email protected]
| # | Description of Services | Date | Qty | Unit Price (EUR) | Total (EUR) |
|---|---|---|---|---|---|
| 1 |
Initial Psychiatric Consultation Comprehensive psychiatric assessment including medical history review, mental status examination, and diagnostic formulation. Conducted at the Brussels clinic. |
Oct 10, 2023 | 1 | 120.00 | 120.00 |
| 2 |
Follow-up Psychiatric Session Medication management review and therapeutic progress evaluation. |
Oct 17, 2023 | 1 | 95.00 | 95.00 |
| 3 |
Psychiatric Report for Employer Detailed medical report regarding fitness for work, prepared in accordance with Belgian labor regulations and privacy laws. |
Oct 20, 2023 | 1 | 150.00 | 150.00 |
| 4 |
Emergency Teleconsultation Urgent psychiatric evaluation conducted via secure video link due to acute anxiety episode. |
Oct 22, 2023 | 1 | 110.00 | 110.00 |
| Subtotal: | 475.00 EUR |
| VAT (21%): | 99.75 EUR |
| Total Amount Due: | 574.75 EUR |
Payment Instructions
Please transfer the total amount to the following bank account within 30 days:
Bank Name: KBC Bank Brussels
Account Holder: Dr. Elena Vandenberghe
IBAN: BE68 5390 0754 7032
BIC/SWIFT: KREDBEBB
Reference: INV-2023-10-045
Please include the invoice number as the payment reference to ensure proper allocation.
Important Notes Regarding This Invoice
This invoice represents the professional fees for psychiatric services rendered by Dr. Elena Vandenberghe, a licensed psychiatrist practicing in Brussels, Belgium. The services provided adhere to the ethical standards set by the Royal Belgian Medical Association and comply with Belgian healthcare regulations.
RIZIV/INAMI Reimbursement: Please note that this invoice is issued for private payment. However, certain psychiatric consultations may be eligible for partial reimbursement through the Belgian national health insurance fund (RIZIV/INAMI). Patients are advised to submit this invoice along with their medical card to their respective mutual insurance fund (mutuelle) for potential reimbursement according to current Belgian healthcare policies.
Privacy and Confidentiality: All patient information contained within this invoice and related medical records is protected under the Belgian Privacy Act and the European General Data Protection Regulation (GDPR). This document should be handled with confidentiality and shared only with relevant parties for billing or insurance purposes.
Late Payment: In accordance with Belgian law regarding late payment of commercial debts, interest may be charged on overdue amounts after the due date has passed. Please contact the practice immediately if you anticipate any difficulties in meeting the payment deadline.
Disputes: Any disputes regarding this invoice should be directed to the practice office within 14 days of the invoice date. Dr. Vandenberghe is committed to resolving any billing concerns promptly and professionally.
Thank you for trusting our psychiatric care services in Brussels. We are dedicated to providing high-quality mental health support in a compassionate and professional environment.
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