Invoice Psychiatrist in Qatar Doha –Free Word Template Download with AI
Specialized Psychiatry & Behavioral Health Services
Al Waab Street, Building 45, Office 202
Doha, Qatar
P.O. Box: 23456
Phone: +974 4455 6677
Email: [email protected]
VAT Reg: 10012345678| Invoice Number: | INV-QA-2023-0892 |
| Date of Issue: | October 24, 2023 |
| Due Date: | November 24, 2023 |
| Payment Status: | Pending |
Bill To (Patient/Guarantor)
Name: Mr. Ahmed Al-Thani
Address: Villa 12, Block A, Lusail City
City: Doha, Qatar
Phone: +974 3344 5566
Email: [email protected]
National ID: 2980XXXXXXX
Insurance Details (If Applicable)
Provider: Bupa Arabia / Qatar
Policy Number: BUP-QA-998877
Group ID: GRP-554433
Authorization Ref: AUTH-2023-1122
Co-pay Amount: QAR 150.00
| Description of Psychiatry Services | Code | Date | Qty | Unit Price (QAR) | Total (QAR) |
|---|---|---|---|---|---|
|
Initial Comprehensive Psychiatric Evaluation Detailed assessment including clinical history, mental status examination, and diagnostic formulation conducted by a board-certified Psychiatrist in Doha. Includes review of previous medical records and family history. |
90791 | Oct 10, 2023 | 1 | 850.00 | 850.00 |
|
Psychiatric Follow-up Consultation (45 mins) Routine management of mood disorder, medication adjustment, and therapeutic monitoring. Conducted at our Al Waab clinic in Doha, Qatar. |
90792 | Oct 17, 2023 | 1 | 450.00 | 450.00 |
|
Psychological Testing & Interpretation Administration and scoring of standardized cognitive and emotional assessment tools (e.g., PHQ-9, GAD-7, MMPI-2) to support diagnostic accuracy. |
96130 | Oct 10, 2023 | 1 | 600.00 | 600.00 |
|
Medication Management & Prescription Detailed review of pharmacological regimen, side effect monitoring, and issuance of prescription compliant with Qatar Ministry of Public Health regulations. |
90863 | Oct 17, 2023 | 1 | 200.00 | 200.00 |
|
Family Psychoeducation Session One-on-one session with family members to discuss diagnosis, treatment plan, and coping strategies within the cultural context of Qatar. |
90833 | Oct 20, 2023 | 1 | 500.00 | 500.00 |
| Subtotal: | QAR 2,600.00 |
| VAT (10%): | QAR 260.00 |
| Insurance Co-pay (Deducted): | - QAR 150.00 |
| Total Due: | QAR 2,710.00 |
Terms and Conditions
1. Payment is due within 30 days of the invoice date. Late payments may incur a 2% monthly interest charge.
2. This invoice is issued in accordance with the Qatar Tax Authority regulations. VAT is applied at the standard rate of 10%.
3. All psychiatric services provided are confidential and adhere to the highest standards of medical ethics and patient privacy.
4. Insurance claims must be submitted with this invoice and the detailed clinical report within 60 days.
5. For any discrepancies or questions regarding this invoice, please contact our billing department in Doha.
6. Please quote the Invoice Number (INV-QA-2023-0892) in all correspondence and payments.
Payment Methods
Bank Transfer:
Bank Name: Qatar National Bank (QNB)
Account Name: Qatar Mental Wellness Clinic W.L.L.
IBAN: QA30 XXXX XXXX XXXX XXXX XXXX
SWIFT: QNBAAQDA
Credit Card: Visa, MasterCard, and Amex accepted via secure online portal.
Authorized Signature
Dr. Sarah Al-Mansoori
Chief Psychiatrist
Patient/Guarantor Signature
Date: _______________
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