Invoice Psychiatrist in Japan Tokyo –Free Word Template Download with AI
3-14-7 Shinjuku, Shinjuku-ku, Tokyo 160-0022, Japan
Tel: +81-3-5555-0199 | Email: [email protected]
Corporate Number: 1234567890123
Medical Practitioner License No. 10-123456
Invoice Number: INV-2023-10-089
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Service Period: October 1, 2023 - October 31, 2023
Bill To:
Mr. Hiroshi Tanaka
2-5-1 Roppongi, Minato-ku, Tokyo 106-0032, Japan
Insurance Provider: Tokyo Mutual Health Insurance
Policy Number: TMHI-99887766
| # | Description of Services | Date | Quantity | Amount (JPY) |
|---|---|---|---|---|
| 1 |
Initial Comprehensive Psychiatric Evaluation Detailed clinical assessment conducted by a licensed Psychiatrist in Tokyo. Includes medical history review, mental status examination, and diagnostic formulation according to DSM-5 and ICD-11 standards. |
Oct 02, 2023 | 1 | ¥ 25,000 |
| 2 |
Individual Psychotherapy Session (60 mins) Cognitive Behavioral Therapy (CBT) session focusing on anxiety management and stress reduction techniques tailored for the fast-paced environment of Japan Tokyo. |
Oct 09, 2023 | 1 | ¥ 18,000 |
| 3 |
Psychiatric Medication Management Consultation Review of current pharmacological regimen, dosage adjustment, and monitoring of side effects. Includes prescription issuance for controlled substances compliant with Japanese Ministry of Health regulations. |
Oct 16, 2023 | 1 | ¥ 12,000 |
| 4 |
Follow-up Psychotherapy Session (45 mins) Progress evaluation and continuation of therapeutic interventions. Discussion of coping strategies for workplace stress common in Tokyo corporate sectors. |
Oct 23, 2023 | 1 | ¥ 15,000 |
| 5 |
Psychological Testing Administration & Scoring Administration of standardized psychological tests (e.g., HAMA, HAMD) to quantify symptom severity. Includes interpretation of results by the attending Psychiatrist. |
Oct 02, 2023 | 1 | ¥ 10,000 |
| 6 |
Medical Documentation & Insurance Filing Preparation of detailed medical reports for insurance reimbursement purposes. Ensures compliance with Japanese National Health Insurance (NHI) documentation requirements. |
Oct 30, 2023 | 1 | ¥ 5,000 |
Payment Instructions & Terms
Bank Transfer Details:
Bank Name: Mizuho Bank, Shinjuku Branch
Account Type: Ordinary Account (Futsu)
Account Number: 1234567
Account Name: Shinjuku Psychiatry & Wellness Center
SWIFT Code: MHCBJPJT
Terms:
Payment is due within 30 days of the invoice date. Please include the Invoice Number (INV-2023-10-089) in the payment reference. Late payments may incur a 1.5% monthly interest charge. For international payments, please ensure all bank fees are covered by the sender.
Privacy Notice:
In accordance with the Japanese Act on the Protection of Personal Information (APPI), all patient data and financial information are handled with strict confidentiality. This invoice contains sensitive medical billing information and should be kept secure.
Authorized Signature:
Dr. Kenji Sato, M.D., Ph.D.
Chief Psychiatrist
Received By:
Date: _______________
Signature: _______________
⬇️ Download as DOCX Edit online as DOCXCreate your own Word template with our GoGPT AI prompt:
GoGPT