Invoice Psychiatrist in Ghana Accra –Free Word Template Download with AI
Professional Psychiatrist Services
15 Independence Avenue, East Legon
Accra, Greater Accra Region, Ghana
Tel: +233 30 277 8899 | Email: [email protected]
License No: GPC-Psych-2024-0892
Official Payment Request
Bill To:
Mr. Kwame Asante
42 Osu Oxford Street
Osu, Accra, Ghana
NHIS Number: NHIS-GH-2024-778899
Email: [email protected]
Phone: +233 24 555 1234
Professional Psychiatrist Services Rendered
This invoice details the comprehensive psychiatric care and mental health services provided by our licensed Psychiatrist team at the Accra Mental Health & Psychiatry Center. All services were delivered in accordance with the standards set by the Ghana Medical Council and the Ghana Psychiatric Association. Our Psychiatrist specialists have provided evidence-based treatment, diagnostic assessments, and therapeutic interventions tailored to your specific mental health needs within the Ghana Accra healthcare framework.
| # | Description of Psychiatrist Services | Date | Qty | Unit Price (GHS) | Total (GHS) |
|---|---|---|---|---|---|
| 1 | Initial Comprehensive Psychiatric Evaluation and Diagnostic Assessment by Senior Psychiatrist | Oct 05, 2024 | 1 | 850.00 | 850.00 |
| 2 | Follow-up Psychiatrist Consultation - Medication Management and Treatment Plan Review | Oct 12, 2024 | 1 | 450.00 | 450.00 |
| 3 | Cognitive Behavioral Therapy (CBT) Session conducted by Licensed Psychiatrist | Oct 15, 2024 | 1 | 550.00 | 550.00 |
| 4 | Psychiatric Medication Prescription and Pharmacological Management Review | Oct 12, 2024 | 1 | 200.00 | 200.00 |
| 5 | Follow-up Psychiatrist Consultation - Progress Assessment and Therapy Adjustment | Oct 19, 2024 | 1 | 450.00 | 450.00 |
| 6 | Individual Psychotherapy Session with Psychiatrist - Emotional Regulation Focus | Oct 22, 2024 | 1 | 550.00 | 550.00 |
| 7 | Psychiatric Assessment Report Preparation for NHIS and Insurance Documentation | Oct 25, 2024 | 1 | 350.00 | 350.00 |
| 8 | Family Consultation Session with Psychiatrist - Support System Integration | Oct 28, 2024 | 1 | 700.00 | 700.00 |
| 9 | Follow-up Psychiatrist Consultation - End of Month Treatment Review | Oct 31, 2024 | 1 | 450.00 | 450.00 |
| 10 | Psychiatric Emergency Consultation Fee (After-Hours Availability) | Oct 18, 2024 | 1 | 600.00 | 600.00 |
| Subtotal: | GHS 5,150.00 |
| NHIS Covered Amount: | - GHS 1,500.00 |
| Out-of-Pocket Balance: | GHS 3,650.00 |
| VAT (15% on out-of-pocket): | GHS 547.50 |
| Grand Total Due: | GHS 4,197.50 |
Payment Instructions - Ghana Accra
Payment is due within 30 days of the invoice date.
Mobile Money (MTN MoMo / Vodafone Cash / AirtelTigo Money):
Number: +233 24 777 8899 | Name: Accra Mental Health Center
Bank Transfer:
Bank: Ecobank Ghana Limited
Branch: East Legon, Accra
Account Name: Accra Mental Health & Psychiatry Center Ltd.
Account Number: 1001234567890
Sort Code: 012345
Reference: Please use Invoice Number INV-ACC-2024-0456 as payment reference.
Cash Payments: Accepted at our clinic in East Legon, Accra during business hours (Monday-Friday, 8:00 AM - 5:00 PM).
Important Notes Regarding This Psychiatrist Invoice:
1. This invoice represents professional Psychiatrist services rendered at our facility in Ghana Accra. All treatments were administered by licensed Psychiatrists registered with the Ghana Medical Council and the Ghana Psychiatric Association.
2. The National Health Insurance Scheme (NHIS) of Ghana has covered a portion of these services as indicated. Please ensure your NHIS membership is active for continued coverage of Psychiatrist services.
3. Late payments may incur a penalty of 2% per month on the outstanding balance. Please contact our billing department at [email protected] if you experience any difficulties with payment.
4. All Psychiatrist consultations and treatments documented in this invoice are confidential and protected under Ghana's Data Protection Act, 2012 (Act 843) and medical ethics guidelines.
5. Please retain this invoice for your personal records and for any insurance claims or reimbursement purposes. A duplicate copy can be requested from our office in Accra.
6. Our Psychiatrist team is committed to providing the highest standard of mental health care in Ghana Accra. If you have any questions about the services provided or this invoice, please do not hesitate to contact us.
7. This invoice is valid for payment within 90 days from the date of issue. After this period, a new invoice may need to be generated.
Authorized by:
Dr. Ama Mensah, MBChB, MMed (Psychiatry)
Lead Psychiatrist
Accra Mental Health & Psychiatry Center
Signature: ___________________
Date: November 15, 2024
Received by (Patient):
Name: ___________________
Signature: ___________________
Date: ___________________
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