Invoice Psychiatrist in Israel Jerusalem –Free Word Template Download with AI
Board-Certified Psychiatrist
Jerusalem Psychiatric & Wellness Center
12 HaYehudim Street, Jerusalem 9425012, Israel
Phone: +972-2-555-0123
Email: [email protected]
VAT Registration Number: 512345678
Invoice Number: INV-2024-0892
Date Issued: January 15, 2024
Due Date: February 14, 2024
Service Period: January 1, 2024 - January 15, 2024
Billed To:
Mr. David Levi
45 King George Street, Jerusalem 9425012, Israel
Phone: +972-50-123-4567
Email: [email protected]
National ID: 123456789
| Service Description | Date of Service | Quantity | Unit Price (ILS) | VAT (17%) | Total (ILS) |
|---|---|---|---|---|---|
| Initial Psychiatric Evaluation - Comprehensive assessment including medical history review, mental status examination, and diagnostic formulation in accordance with DSM-5-TR criteria | January 2, 2024 | 1 | 850.00 | 144.50 | 994.50 |
| Follow-up Psychiatric Consultation - Medication management review, symptom monitoring, and treatment plan adjustment session | January 9, 2024 | 1 | 550.00 | 93.50 | 643.50 |
| Psychiatric Assessment Report - Detailed clinical documentation prepared for insurance company and referring physician, including diagnostic impressions and treatment recommendations | January 10, 2024 | 1 | 400.00 | 68.00 | 468.00 |
| Emergency Psychiatric Consultation - Urgent assessment conducted outside regular hours for acute symptom management and crisis intervention | January 12, 2024 | 1 | 750.00 | 127.50 | 877.50 |
| Psychiatric Medication Management - Prescription review, dosage adjustment, and monitoring of therapeutic response and potential side effects | January 15, 2024 | 1 | 450.00 | 76.50 | 526.50 |
| Subtotal: | 2,000.00 ILS |
| VAT (17%): | 340.00 ILS |
| Grand Total: | 2,340.00 ILS |
Amount in words: Two thousand three hundred forty New Israeli Shekels only
Payment Instructions
Bank Transfer Details:
Bank: Bank Hapoalim, Jerusalem Branch
Account Name: Dr. Sarah Cohen Psychiatric Services Ltd.
Account Number: 99999-123456-7
SWIFT Code: POALILIT
Payment Methods Accepted: Bank transfer, credit card (Visa, MasterCard), or cash payment at our Jerusalem office.
Reference: Please include Invoice Number INV-2024-0892 with your payment.
Payment Deadline: Payment is due within 30 days from the invoice date. Late payments may incur a 1.5% monthly interest charge in accordance with Israeli law.
Important Notes
This invoice is issued in accordance with the Israeli Value Added Tax Law, 1975, and all applicable regulations governing medical services in Israel. The services provided by this psychiatrist are rendered in compliance with the standards set by the Israeli Psychiatric Association and the Ministry of Health.
All psychiatric evaluations and treatments conducted in Jerusalem follow evidence-based clinical guidelines and maintain the highest standards of patient confidentiality as required by Israeli privacy legislation.
Insurance claims: This invoice can be submitted to your health maintenance organization (Kupat Holim) or private insurance provider for reimbursement according to your policy terms. Please retain a copy of this invoice for your records.
For questions regarding this invoice or your psychiatric care, please contact our Jerusalem office during business hours (Sunday-Thursday, 8:00 AM - 5:00 PM).
Thank you for trusting our psychiatric services in Jerusalem, Israel.
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