Invoice Psychiatrist in Spain Madrid –Free Word Template Download with AI
Specialist Psychiatrist
Calle de Serrano, 45, 2ºB
28001 Madrid, Spain
NIF: B-12345678
Phone: +34 91 123 4567
Email: [email protected]
Invoice Number: INV-2023-10-045
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Service Period: October 1, 2023 - October 31, 2023
Bill To:
Global Health Insurance Group
Attn: Claims Department
Av. de la Castellana, 100
28046 Madrid, Spain
NIF: A-87654321
Policy Holder ID: GH-998877
Patient Information:
Name: Juan Carlos Mendez
Date of Birth: 15/05/1985
Address: Calle Velazquez, 12, Madrid
SS Number: 12345678Z
Diagnosis Code (ICD-10): F41.1 (Generalized Anxiety Disorder)
| # | Description of Services | Date | Qty | Unit Price (€) | Total (€) |
|---|---|---|---|---|---|
| 1 |
Initial Psychiatric Evaluation Comprehensive assessment including clinical interview, medical history review, and diagnostic formulation. Conducted at the clinic in Madrid. |
01/10/2023 | 1 | 150.00 | 150.00 |
| 2 |
Individual Psychotherapy Session (CBT) Cognitive Behavioral Therapy session focused on anxiety management techniques and coping strategies. Duration: 50 minutes. |
08/10/2023 | 1 | 110.00 | 110.00 |
| 3 |
Individual Psychotherapy Session (CBT) Follow-up session reviewing progress on exposure exercises and cognitive restructuring. Duration: 50 minutes. |
15/10/2023 | 1 | 110.00 | 110.00 |
| 4 |
Psychiatric Medication Management Review of current pharmacological treatment, dosage adjustment, and monitoring of side effects. Includes prescription issuance. |
22/10/2023 | 1 | 90.00 | 90.00 |
| 5 |
Individual Psychotherapy Session (CBT) Session focused on relapse prevention planning and long-term maintenance strategies. Duration: 50 minutes. |
29/10/2023 | 1 | 110.00 | 110.00 |
| 6 |
Clinical Report for Insurance Detailed medical report summarizing diagnosis, treatment plan, and progress notes for insurance coverage verification. |
31/10/2023 | 1 | 75.00 | 75.00 |
| Subtotal: | 645.00 € |
| VAT (IVA) 21%: | 135.45 € |
| Total Amount Due: | 780.45 € |
Payment Instructions & Terms
Bank Transfer Details:
Bank Name: Banco Santander, Spain
IBAN: ES91 2100 0418 4502 0005 1332
BIC/SWIFT: BSCHESMM
Beneficiary: Dr. Elena Rodriguez
Please reference Invoice Number INV-2023-10-045 in the transfer description.
Terms:
Payment is due within 30 days of the invoice date. Late payments may incur a penalty interest rate of 5% per annum as per Spanish commercial law. This invoice is issued in accordance with the regulations of the Madrid College of Physicians (Colegio Oficial de Médicos de Madrid).
Privacy Notice:
In compliance with the General Data Protection Regulation (GDPR) and Spanish Organic Law 3/2018 on Personal Data Protection, the patient's data included in this invoice is processed solely for billing and medical record-keeping purposes. Access to this information is restricted to authorized personnel.
Authorized Signature
Dr. Elena Rodriguez
Psychiatrist
Date of Signature
October 24, 2023
Madrid, Spain
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