Invoice Psychiatrist in Saudi Arabia Riyadh –Free Word Template Download with AI
Licensed Healthcare Provider - Ministry of Health, Saudi Arabia
Commercial Registration (CR): 1010XXXXXX
VAT Registration Number: 3000XXXXXXX
Address: Olaya District, King Fahd Road, Building 45, Floor 3
Riyadh, 12211, Saudi Arabia
Phone: +966 11 XXX XXXX | Email: [email protected]
Invoice Number: INV-2024-0892
Date of Issue: October 24, 2024
Due Date: November 24, 2024
Service Period: October 1, 2024 - October 24, 2024
BILL TO:
Patient Name: [Patient Full Name]
National ID / Iqama Number: [ID Number]
Phone: +966 5X XXX XXXX
Email: [[email protected]]
Insurance Provider: [Insurance Company Name]
Policy Number: [Policy Number]
Group Number: [Group Number]
Address: [Patient Address in Riyadh]
Download and customize a professional Invoice Psychiatrist Saudi Arabia Riyadh Word template. Perfect for business, legal, and personal use. Editable and ready to boost your productivity. OF PSYCHIATRIC SERVICES RENDERED
| # | Service Description | Date | Qty | Unit Price (SAR) | Total (SAR) |
|---|---|---|---|---|---|
| 1 | Initial Comprehensive Psychiatric Evaluation and Diagnostic Assessment | Oct 01, 2024 | 1 | 850.00 | 850.00 |
| 2 | Follow-up Consultation with Board-Certified Psychiatrist (45 min session) | Oct 08, 2024 | 1 | 550.00 | 550.00 |
| 3 | Follow-up Consultation with Board-Certified Psychiatrist (45 min session) | Oct 15, 2024 | 1 | 550.00 | 550.00 |
| 4 | Follow-up Consultation with Board-Certified Psychiatrist (45 min session) | Oct 22, 2024 | 1 | 550.00 | 550.00 |
| 5 | Psychiatric Medication Management and Prescription Review | Oct 22, 2024 | 1 | 200.00 | 200.00 |
| 6 | Psychological Testing Battery (Cognitive and Mood Assessment) | Oct 10, 2024 | 1 | 1,200.00 | 1,200.00 |
| 7 | Interpretation of Psychological Test Results and Report Generation | Oct 18, 2024 | 1 | 400.00 | 400.00 |
| 8 | Emergency Psychiatric Consultation (After-Hours Service) | Oct 12, 2024 | 1 | 750.00 | 750.00 |
PAYMENT INSTRUCTIONS
Please remit payment within 30 days of the invoice date. Payments can be made via bank transfer, credit card, or SADAD payment system.
Bank Name: Al Rajhi Bank
Account Name: Riyadh Mental Health & Psychiatry Center
IBAN: SA03 8000 0000 6080 1016 7519
SADAD Reference: 123456789
SWIFT Code: NATIONALSA
IMPORTANT TERMS AND CONDITIONS:
- This invoice is issued in accordance with the regulations of the Zakat, Tax and Customs Authority (ZATCA) of Saudi Arabia.
- All psychiatric services provided are conducted by licensed psychiatrists registered with the Saudi Commission for Health Specialties (SCFHS).
- VAT at 15% is mandatory and non-negotiable as per Saudi Arabian tax law.
- Insurance claims should be submitted directly to the respective insurance provider with this invoice as supporting documentation.
- Late payments may incur a penalty of 2% per month on the outstanding balance.
- All patient information is kept strictly confidential in compliance with Saudi Arabia's Personal Data Protection Law.
- Any disputes regarding this invoice must be raised within 15 days of receipt.
- This invoice is valid for services rendered at our Riyadh clinic located in Olaya District.
Authorized By:
Dr. Ahmed Al-RashidChief Psychiatrist
Riyadh Mental Health & Psychiatry Center
Patient Acknowledgment:
Patient SignatureDate: _______________ ⬇️ Download as DOCX Edit online as DOCX
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