Invoice Psychiatrist in China Guangzhou –Free Word Template Download with AI
No. 188 Tianhe Road, Tianhe District
Guangzhou, Guangdong Province, China
Postal Code: 510000
Tel: +86 20 8888 9999
Email: [email protected]
Unified Social Credit Code: 91440106MA5XXXXX
Invoice Number: GZ-PSY-2023-10-045
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Service Period: October 1, 2023 - October 23, 2023
Bill To:
Mr. Zhang Wei
Room 1204, Tower B, IFC Mall
Zhujiang New Town, Tianhe District
Guangzhou, Guangdong, China
ID Number: 4401061985XXXXXXXX
Phone: +86 138 0000 0000
Payment Instructions:
Bank Name: Industrial and Commercial Bank of China (ICBC)
Branch: Tianhe Branch, Guangzhou
Account Name: Guangzhou MindCare Psychiatry Center Co., Ltd.
Account Number: 4000 1234 5678 9012 345
Currency: Chinese Yuan (CNY / RMB)
SWIFT Code: ICBKCNBJ
| # | Description of Psychiatrist Services | Date | Qty | Unit Price (CNY) | Total (CNY) |
|---|---|---|---|---|---|
| 1 |
Initial Comprehensive Psychiatric Evaluation Detailed clinical interview conducted by a licensed Psychiatrist in Guangzhou to assess mental health status, medical history, and current symptoms. Includes diagnostic formulation according to ICD-11 standards. |
Oct 02 | 1 | 1,200.00 | 1,200.00 |
| 2 |
Psychopharmacological Management Consultation Prescription review and medication adjustment session. The Psychiatrist evaluated the efficacy of current treatment and prescribed necessary adjustments for mood stabilization. |
Oct 09 | 1 | 800.00 | 800.00 |
| 3 |
Cognitive Behavioral Therapy (CBT) Session One-on-one therapy session provided by the attending Psychiatrist. Focus on cognitive restructuring and behavioral activation techniques tailored for the patient's specific condition. |
Oct 12 | 1 | 900.00 | 900.00 |
| 4 |
Follow-up Psychiatric Assessment Routine follow-up appointment to monitor progress, side effects of medication, and overall mental well-being. Includes brief psychological testing. |
Oct 16 | 1 | 600.00 | 600.00 |
| 5 |
Emergency Psychiatric Consultation Urgent after-hours consultation provided by the on-call Psychiatrist at our Guangzhou facility regarding acute anxiety episode. Includes crisis intervention and safety planning. |
Oct 18 | 1 | 1,500.00 | 1,500.00 |
| 6 |
Psychiatric Report Generation Preparation of a detailed medical report summarizing the diagnosis, treatment plan, and prognosis. This document is suitable for insurance claims or workplace accommodations in China. |
Oct 20 | 1 | 500.00 | 500.00 |
| Subtotal: | 5,500.00 CNY |
| Value Added Tax (VAT) @ 6%: | 330.00 CNY |
| Discount (Loyalty Program): | -100.00 CNY |
| Grand Total Due: | 5,730.00 CNY |
Terms and Conditions & Important Notes:
- Payment Terms: Payment is due within 30 days from the date of this Invoice. Late payments may incur a penalty fee of 1.5% per month.
- Currency: All amounts are quoted in Chinese Yuan (CNY). For international payments, exchange rates apply at the time of transaction.
- Medical Confidentiality: As a licensed Psychiatrist practice in Guangzhou, we adhere strictly to the Personal Information Protection Law (PIPL) of China. Your medical records and financial data are kept confidential.
- Insurance: This Invoice can be submitted to your health insurance provider. Please ensure you attach the detailed medical report if required by your insurer.
- Disputes: Any disputes regarding this Invoice should be raised within 14 days of receipt. Please contact our billing department at [email protected].
- Validity: This Invoice is valid for tax deduction purposes in accordance with the regulations of the State Taxation Administration of China.
- Service Location: All services listed above were rendered at our primary clinic located in the Tianhe District of Guangzhou, China, unless otherwise specified as telemedicine.
Authorized By:
Dr. Li Ming, MD, PhD
Chief Psychiatrist
Guangzhou MindCare Psychiatry Center
License No: 440106-PSY-2015-001
Received By:
_________________________
Name:
Date:
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