Invoice Psychiatrist in Israel Tel Aviv –Free Word Template Download with AI
Advanced Mental Health Services
12 Herzl Street, Tel Aviv-Yafo, Israel
Phone: +972-3-555-0199 | Email: [email protected]
#INV-2023-TLV-8842
Issued By (Provider)
Dr. Sarah Cohen, MD Board Certified Psychiatrist License No: IL-PSY-44921 VAT ID (HPR): 512345678 Date Issued: October 24, 2023 Due Date: November 24, 2023Bill To (Client/Patient)
Mr. David Levi Address: 45 Rothschild Blvd, Tel Aviv, Israel ID Number: 001234567 Insurance Provider: Clalit Health Services (Private) Policy Number: CLT-99887766 Service Overview: This invoice details the professional psychiatric services rendered by Dr. Sarah Cohen at the Tel Aviv Psychiatry Center. These services include clinical assessment, psychotherapy sessions, and medication management in accordance with the standards of the Israeli Medical Association. All treatments were conducted in Tel Aviv, Israel, adhering to local privacy laws and medical regulations.| # | Description of Psychiatric Services | Date of Service | Quantity | Amount (ILS) |
|---|---|---|---|---|
| 1 |
Initial Comprehensive Psychiatric Evaluation Includes full history taking, mental status examination, and diagnostic formulation. |
Oct 10, 2023 | 1 | 1,200.00 |
| 2 |
Individual Psychotherapy Session (CBT) 50-minute session focusing on anxiety management techniques. |
Oct 17, 2023 | 1 | 650.00 |
| 3 |
Medication Management Consultation Review of current pharmacotherapy, dosage adjustment, and prescription renewal. |
Oct 24, 2023 | 1 | 450.00 |
| 4 |
Psychiatric Report for Insurance Detailed clinical summary prepared for private insurance reimbursement. |
Oct 24, 2023 | 1 | 300.00 |
Payment Instructions
Please remit payment within 30 days of the invoice date. Late payments may incur a statutory interest fee as per Israeli law.
Bank Transfer Details:
- Bank: Bank Hapoalim, Tel Aviv Branch
- Account Name: Tel Aviv Psychiatry Center Ltd.
- Account Number: 9988776655
- SWIFT/BIC: POALILIT
- Reference: INV-2023-TLV-8842
Note: For international transfers, please ensure the currency is converted to Israeli New Shekels (ILS) prior to transfer to avoid exchange rate discrepancies.
Terms and Conditions:- This invoice is valid for services rendered in Tel Aviv, Israel, under the supervision of a licensed Psychiatrist.
- VAT is calculated at the standard Israeli rate of 17% applicable to private medical services not covered by the National Health Insurance Law.
- Payment is due within 30 days. If payment is not received by the due date, a late fee of 1.5% per month may be applied.
- Disputes regarding this invoice must be raised in writing within 14 days of receipt.
- All patient data is handled in strict confidence according to the Israeli Privacy Protection Law.
Create your own Word template with our GoGPT AI prompt:
GoGPT