Invoice Psychiatrist in France Paris –Free Word Template Download with AI
15 Avenue de l'Opéra
75001 Paris, France
Tel: +33 1 42 60 00 00
Email: [email protected]
SIRET: 823 456 789 00012
TVA Intracommunautaire: FR 12 823 456 789
RPPS: 10004750123
INVOICE
Bill To:
Monsieur Alexandre Martin
42 Rue de Rivoli
75004 Paris, France
Patient ID: PAT-88291
CPAM Paris (Assurance Maladie)
Mutual: Groupama Santé
Social Security Number (NIR): 1 85 04 75 100 123 45
| Description / CCAM Code | Date | Quantity | Amount (EUR) |
|---|---|---|---|
|
Initial Psychiatric Consultation Code: 100041598 - First consultation with psychiatric assessment and diagnosis formulation. |
Oct 02, 2023 | 1 | € 95.00 |
|
Psychiatric Follow-up Consultation Code: 100041604 - Standard follow-up session for monitoring treatment efficacy and patient stability. |
Oct 09, 2023 | 1 | € 75.00 |
|
Extended Psychiatric Consultation Code: 100041612 - Extended session involving complex case management and medication adjustment. |
Oct 16, 2023 | 1 | € 110.00 |
|
Psychological Testing & Evaluation Code: 100041620 - Administration and interpretation of standardized psychiatric scales (e.g., HAM-D, PANSS). |
Oct 16, 2023 | 1 | € 150.00 |
|
Medical Certificate Issuance Code: 100041638 - Official medical certificate regarding fitness for work or sick leave (Arrêt de travail). |
Oct 23, 2023 | 1 | € 40.00 |
Payment Methods: This invoice may be settled via bank transfer, check, or credit card. Please reference the Invoice Number (INV-2023-10-045) on all payments.
Bank Details:
Bank: Crédit Agricole Paris
IBAN: FR76 3000 4000 0100 0000 0000 001
BIC: AGRIFRPP
Insurance Information: As per French regulations, this invoice is formatted to be compatible with the "Tiers Payant" system. The patient is responsible for the remaining balance after the statutory reimbursement from the French Social Security system (Assurance Maladie) and their complementary mutual insurance.
Confidentiality: This document contains sensitive medical billing information protected under French data protection laws (RGPD/GDPR). It is intended solely for the recipient named above.
⬇️ Download as DOCX Edit online as DOCXCreate your own Word template with our GoGPT AI prompt:
GoGPT