Invoice Psychiatrist in Canada Montreal –Free Word Template Download with AI
Board-Certified Psychiatrist
Ordre des médecins du Québec (OMQ) #123456
1200 Avenue McGill College, Suite 400
Montreal, Quebec, Canada H3B 4G7
Phone: (514) 555-0199 | Email: [email protected]
Invoice Number: INV-2023-10-045
Date Issued: October 24, 2023
Due Date: November 24, 2023
Service Period: October 1, 2023 - October 23, 2023
Bill ToMr. Jonathan Tremblay
456 Rue Saint-Denis
Montreal, Quebec, Canada H2X 3K1
Insurance Provider: Sun Life Financial
Policy Number: SL-99887766
Group Number: GRP-554433
Description of Services RenderedThe following invoice details psychiatric services provided in accordance with the standards of the College of Physicians and Surgeons of Quebec. All fees are listed in Canadian Dollars (CAD) and are subject to the applicable Goods and Services Tax (GST) as per federal regulations. Please note that while some extended health insurance plans in Canada Montreal may cover a portion of these fees, the patient is responsible for any balance not covered by their specific policy.
| # | Description of Service | Date | Fee Code | Qty | Amount (CAD) |
|---|---|---|---|---|---|
| 1 |
Initial Psychiatric Assessment Comprehensive evaluation including clinical history, mental status examination, and diagnostic formulation. Conducted at our Montreal clinic. |
Oct 02, 2023 | 01.01.01 | 1 | $350.00 |
| 2 |
Follow-up Consultation (Medication Management) Review of current pharmacotherapy, side effect monitoring, and adjustment of dosage. |
Oct 09, 2023 | 01.01.02 | 1 | $225.00 |
| 3 |
Follow-up Consultation (Therapeutic Review) Discussion of progress, coping strategies, and coordination with external psychotherapist. |
Oct 16, 2023 | 01.01.02 | 1 | $225.00 |
| 4 |
Psychiatric Report for Employer Preparation of a formal medical note regarding fitness for work and recommended accommodations, compliant with Quebec employment standards. |
Oct 20, 2023 | 01.01.05 | 1 | $175.00 |
| 5 |
Urgent Telephone Consultation Brief crisis intervention and safety planning via secure telehealth platform. |
Oct 23, 2023 | 01.01.03 | 1 | $100.00 |
Payment Instructions & Terms
Payment is due within 30 days of the invoice date. Please make checks payable to "Dr. Elena Vance" or use the direct deposit information below. For credit card payments, a 2.5% processing fee applies.
Direct Deposit (Interac e-Transfer): [email protected]
Bank Transfer: RBC Royal Bank, Montreal Branch
Transit: 00234 | Institution: 003 | Account: 12345678
Insurance Reimbursement
This invoice is provided for your records and for submission to your private insurance provider. Please note that the Quebec public health plan (RAMQ) does not cover private psychiatric services for adults unless specific criteria are met. Most extended health plans in Canada Montreal offer partial reimbursement for psychiatrist visits. We recommend contacting your provider directly to confirm your coverage limits and deductibles.
Confidentiality Notice
This document contains confidential medical billing information protected under the Quebec Act respecting the protection of personal information in the private sector (Loi 25). If you have received this invoice in error, please notify us immediately and destroy this document.
⬇️ Download as DOCX Edit online as DOCXCreate your own Word template with our GoGPT AI prompt:
GoGPT