Invoice Psychiatrist in Colombia Medellín –Free Word Template Download with AI
Specialist Psychiatrist
Clinica Psiquiatrica del Valle de Aburrá
Carrera 43A # 12-45, Oficina 302
El Poblado, Medellín, Antioquia, Colombia
NIT: 900.123.456-7
License No. 12345678 (Ministerio de Salud y Protección Social)
Email: [email protected]
Phone: +57 (4) 444-5555
Invoice Number: INV-MED-2023-0892
Date of Issue: October 24, 2023
Due Date: November 07, 2023
Payment Terms: Net 14 Days
Bill To (Insurance Provider / Patient)Seguros Bolívar S.A.
Attn: Claims Department
Calle 68 # 10-45
Medellín, Antioquia, Colombia
NIT: 830.005.000-1
Patient InformationName: Maria Fernanda Gomez Lopez
ID (Cédula): 1.098.765.432
Policy Number: SB-POL-998877
Group Number: GRP-ANT-5544
Description of Psychiatric Services Rendered| Item | Description of Service | Date of Service | Code (CIPS) | Quantity | Unit Price (COP) | Total (COP) |
|---|---|---|---|---|---|---|
| 1 |
Initial Comprehensive Psychiatric Evaluation Detailed clinical interview assessing mental status, history of present illness, past psychiatric history, family history, and social functioning. Includes diagnostic formulation according to DSM-5-TR criteria. Conducted at the clinic in Medellín. |
Oct 10, 2023 | PSY-001 | 1 | $450,000 | $450,000 |
| 2 |
Psychopharmacological Management Session Follow-up consultation for medication adjustment and monitoring of side effects. Review of therapeutic response to current regimen for Major Depressive Disorder. Includes prescription issuance. |
Oct 17, 2023 | PSY-002 | 1 | $320,000 | $320,000 |
| 3 |
Cognitive Behavioral Therapy (CBT) Session Individual psychotherapy session (50 minutes) focusing on cognitive restructuring and behavioral activation techniques. Provided in-person at the El Poblado clinic. |
Oct 17, 2023 | CBT-001 | 1 | $380,000 | $380,000 |
| 4 |
Psychiatric Emergency Consultation Urgent assessment for acute anxiety episode and risk evaluation. Includes crisis intervention and safety planning. Service rendered outside standard hours. |
Oct 20, 2023 | PSY-URG | 1 | $550,000 | $550,000 |
| 5 |
Medical Report for Insurance/Workplace Official documentation summarizing diagnosis, treatment plan, and prognosis for submission to Seguros Bolívar and employer. Includes certification of medical leave if applicable. |
Oct 22, 2023 | DOC-001 | 1 | $150,000 | $150,000 |
Amount in words: One million eight hundred seventy-one thousand two hundred seventy-five Colombian Pesos.
Payment Instructions & Important Notes
Bank Transfer Details:
Bank: Bancolombia S.A.
Account Type: Checking (Corriente)
Account Number: 123-456789-00
Beneficiary: Dr. Alejandro Restrepo M.D.
Reference: INV-MED-2023-0892
Terms and Conditions:
- This invoice is issued in accordance with the tax regulations of the Republic of Colombia and the Superintendencia de Salud.
- Payment is due within 14 days from the date of issue. Late payments may incur a penalty of 1.5% per month.
- All psychiatric services provided are confidential and protected under Colombian medical privacy laws.
- For any discrepancies regarding this invoice, please contact our billing department in Medellín within 5 business days.
- This document serves as proof of payment for tax deduction purposes (Factura Electrónica compatible).
Clinica Psiquiatrica
Medellín Dr. Alejandro Restrepo M.D.
Authorized Signatory
Psychiatrist ⬇️ Download as DOCX Edit online as DOCX
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