Invoice Psychiatrist in Nigeria Abuja –Free Word Template Download with AI
Lead Psychiatrist: Dr. Amina Yusuf, MBBS, FWACP (Psych)
Plot 142, Aguiyi Ironsi Street, Maitama District
Abuja, Federal Capital Territory, Nigeria
Tel: +234 802 123 4567 | Email: [email protected]
TIN: 12345678-0001 | RC: 987654
Invoice #: INV-ABJ-2023-0089
Date: October 24, 2023
Due Date: November 07, 2023
Status: Pending Payment
Bill To:
Mr. Chukwuemeka Okafor
Chief Executive Officer, Okafor Logistics Ltd.
15 Wuse Zone 4, Central Business District
Abuja, Nigeria
Phone: +234 811 987 6543
Insurance / Third Party Payer (If Applicable):
Leadway Assurance Company Ltd.
Health Claims Department
Policy Number: LW-HLT-998877
Group ID: OLOG-GRP-001
Description of Professional Psychiatry Services Rendered in Abuja:
| # | Service Description / Diagnosis Code | Date | Qty | Unit Price (NGN) | Total (NGN) |
|---|---|---|---|---|---|
| 1 |
Initial Comprehensive Psychiatric Evaluation ICD-10: F41.1 (Generalized Anxiety Disorder). Includes detailed clinical history, mental status examination, and risk assessment conducted at Maitama Clinic. |
Oct 10, 2023 | 1 | 45,000.00 | 45,000.00 |
| 2 |
Follow-up Psychiatry Consultation (Session 1) Review of initial findings, formulation of treatment plan, and psychoeducation regarding anxiety management techniques. |
Oct 17, 2023 | 1 | 25,000.00 | 25,000.00 |
| 3 |
Follow-up Psychiatry Consultation (Session 2) Medication titration review and monitoring of side effects. Assessment of therapeutic response. |
Oct 24, 2023 | 1 | 25,000.00 | 25,000.00 |
| 4 |
Psychometric Testing & Interpretation Administration and scoring of Beck Anxiety Inventory (BAI) and Hamilton Depression Rating Scale (HAM-D) to quantify symptom severity. |
Oct 10, 2023 | 1 | 15,000.00 | 15,000.00 |
| 5 |
Prescription Management & Medication Counseling Detailed counseling on pharmacotherapy regimen, adherence strategies, and potential interactions. |
Oct 17, 2023 | 1 | 5,000.00 | 5,000.00 |
| 6 |
Medical Report for Employer/Insurance Confidential summary of fitness for work and recommended leave duration, compliant with Nigerian medical standards. |
Oct 24, 2023 | 1 | 10,000.00 | 10,000.00 |
Payment Instructions
Please remit payment within 14 days of the invoice date. Payments can be made via bank transfer to the following account:
- Bank Name: Zenith Bank Plc
- Account Name: Abuja Mind & Wellness Clinic Ltd.
- Account Number: 1012345678
- Reference: INV-ABJ-2023-0089
Note: Please email proof of payment to [email protected] to confirm receipt.
Terms and Conditions:
- All services rendered are subject to the professional standards of the Medical and Dental Council of Nigeria (MDCN).
- Confidentiality of patient records is maintained in accordance with the Nigerian Data Protection Regulation (NDPR).
- Late payments may incur a penalty interest of 2% per month on the outstanding balance.
- This invoice is valid for tax purposes in the Federal Capital Territory, Abuja.
- Disputes regarding this invoice must be raised within 7 days of receipt.
Thank you for trusting our psychiatric care team with your mental health needs in Abuja.
Authorized By:
Dr. Amina Yusuf
Lead Psychiatrist
Clinic Stamp HereReceived By (Client):
Name: _________________________
Signature: ______________________
Date: __________________________
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