Invoice Psychiatrist in Japan Kyoto –Free Word Template Download with AI
Specialized Psychiatry & Psychotherapy
123 Higashiyama-ku, Sannenzaka
Kyoto, Japan 605-0862
Tel: +81-75-555-0199
Email: [email protected]
Invoice Number: INV-KYO-2023-0892
Date Issued: October 24, 2023
Due Date: November 24, 2023
Service Period: October 1, 2023 - October 23, 2023
Bill To
Mr. Hiroshi Tanaka
45-2 Nakagyo-ku, Kawaramachi Street
Kyoto, Japan 604-8006
Insurance Provider: Kyoto Mutual Health Insurance
Policy Number: KMHI-99887766
| Description of Services | Date | Duration | Unit Price (JPY) | Total (JPY) |
|---|---|---|---|---|
|
Initial Psychiatric Evaluation Comprehensive assessment conducted by Dr. Sarah Jenkins, MD. Includes medical history review, mental status examination, and diagnostic formulation in accordance with DSM-5 standards. |
Oct 02, 2023 | 90 mins | ¥35,000 | ¥35,000 |
|
Psychopharmacology Management Medication review and adjustment session. Discussion of side effects and efficacy of current regimen. Prescription renewal provided. |
Oct 09, 2023 | 30 mins | ¥15,000 | ¥15,000 |
|
Cognitive Behavioral Therapy (CBT) Individual therapy session focusing on anxiety management techniques and cognitive restructuring strategies. |
Oct 12, 2023 | 50 mins | ¥20,000 | ¥20,000 |
|
CBT Follow-up Session Continuation of therapeutic intervention. Review of homework assignments and progress monitoring. |
Oct 19, 2023 | 50 mins | ¥20,000 | ¥20,000 |
|
Administrative & Documentation Fee Preparation of medical reports and insurance claim documentation required by Japanese health authorities. |
Oct 23, 2023 | - | ¥5,000 | ¥5,000 |
Payment Instructions
Please remit payment within 30 days of the invoice date. Late payments may incur a 1.5% monthly interest charge.
Bank Transfer Details:
Bank Name: Mizuho Bank, Kyoto Branch
Account Type: Ordinary Account (Futsu)
Account Number: 1234567
Account Name: Kyoto Mind & Wellness Clinic Co., Ltd.
SWIFT Code: MHCBJPJT
Important Notes Regarding Services in Japan Kyoto
This invoice reflects professional psychiatric services rendered in Kyoto, Japan. As a licensed medical facility operating under the Medical Practitioners Act of Japan, all services provided adhere to the strict ethical and clinical guidelines set forth by the Japanese Psychiatric Society.
The fees listed above are for private insurance billing or self-pay patients. If you are utilizing the Japanese National Health Insurance (NHI) system, please note that this invoice serves as a supplementary statement for services exceeding standard NHI coverage or for specific private consultations requested by the patient.
All patient data and medical records associated with this invoice are stored securely in compliance with the Act on the Protection of Personal Information (APPI). Our clinic is committed to maintaining the highest standards of confidentiality and patient care in the Kyoto region.
For any questions regarding this invoice or your treatment plan, please contact our billing department directly. We appreciate your trust in our psychiatric care services.
⬇️ Download as DOCX Edit online as DOCXCreate your own Word template with our GoGPT AI prompt:
GoGPT