Invoice Psychiatrist in Mexico Mexico City –Free Word Template Download with AI
Specialist in Psychiatry & Psychotherapy
Av. Paseo de la Reforma 222, Piso 15
Col. Juárez, Cuauhtémoc, 06600
Mexico City, Mexico
RFC: RIAA-850412-XY9
License No. 12345678 (SSA)
Email: [email protected]
Invoice Number: INV-2023-10-045
Date of Issue: October 24, 2023
Due Date: November 07, 2023
Payment Terms: Net 14 Days
Bill To (Patient / Insurance Provider)Name: Maria Elena Gonzalez
Address: Calle Insurgentes Sur 1602, Col. Del Valle
City: Benito Juárez, Mexico City, 03100
Phone: +52 55 1234 5678
Email: [email protected]
Insurance Policy: AXA Seguros - Policy #AX-998877
Service Provider DetailsThis invoice represents professional psychiatric services rendered in accordance with the regulations of the Ministry of Health of Mexico and the specific medical protocols established within the Federal District of Mexico City.
Description of Services Rendered| # | Description of Psychiatric Service | Date | Qty | Unit Price (MXN) | Total (MXN) |
|---|---|---|---|---|---|
| 1 | Initial Psychiatric Evaluation and Diagnostic Assessment (CIE-10 Code: F41.1). Includes comprehensive history taking, mental status examination, and risk assessment conducted at the clinic in Mexico City. | Oct 10, 2023 | 1 | 2,500.00 | 2,500.00 |
| 2 | Follow-up Psychiatric Consultation. Medication management review, dosage adjustment for anxiety disorders, and monitoring of side effects. Session duration: 45 minutes. | Oct 17, 2023 | 1 | 1,800.00 | 1,800.00 |
| 3 | Psychopharmacological Prescription and Management Plan. Detailed written report for insurance purposes regarding the necessity of prescribed pharmaceutical interventions. | Oct 17, 2023 | 1 | 500.00 | 500.00 |
| 4 | Emergency Tele-psychiatry Consultation. Urgent assessment conducted via secure video link due to acute exacerbation of symptoms. Compliant with Mexican telemedicine regulations. | Oct 20, 2023 | 1 | 1,200.00 | 1,200.00 |
Bank Transfer (SPEI):
Bank: BBVA México
Account Name: Dr. Alejandro Rivera
CLABE: 012180001234567890
Reference: INV-2023-10-045
Important Notes:
- Please include the invoice number as the reference when making the payment.
- This invoice is valid for reimbursement by private insurance companies operating in Mexico.
- Late payments may incur a penalty of 2% per month as per commercial law in Mexico City.
- For any questions regarding this invoice, please contact the billing department at the email address listed above.
This document serves as a formal request for payment for medical services provided by a licensed Psychiatrist. The services described herein were performed in strict adherence to the ethical guidelines of the Mexican Psychiatric Association and the legal framework governing healthcare in Mexico City. The provider guarantees the confidentiality of all patient information in accordance with the Federal Law on Protection of Personal Data Held by Private Parties (LFPDPPP). This invoice is issued electronically and holds the same legal validity as a paper document under the Federal Law on Electronic Commerce and Digital Signatures. The prices listed are in Mexican Pesos (MXN) and include the applicable Value Added Tax (IVA) as required by the Mexican Tax Administration Service (SAT).
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