Invoice Psychiatrist in Sri Lanka Colombo –Free Word Template Download with AI
No. 45, Galle Road, Colombo 03
Sri Lanka
Tel: +94 11 234 5678 | Email: [email protected]
Web: www.colombomindwellness.lk
Invoice Number: INV-2023-0892
Date of Issue: October 24, 2023
Due Date: November 07, 2023
Payment Terms: Net 14 Days
Bill To (Patient / Insurance Provider)
Mr. Arjuna Perera
12/3, Lake House Road, Colombo 07
Sri Lanka
NIC: 1985XXXXX001
Phone: +94 77 123 4567
Email: [email protected]
Service Provider Details
Dr. Nimali Fernando, MBBS, MRCPsych
Consultant Psychiatrist
Medical Council of Sri Lanka Reg. No: 12345
Colombo Mind & Wellness Clinic
VAT Registration No: 123456789V
Bank: Commercial Bank of Ceylon PLC
Service Description & Clinical Context
This Invoice is issued by Colombo Mind & Wellness Clinic, a premier psychiatric facility located in the heart of Sri Lanka Colombo, for professional mental health services rendered by a qualified Psychiatrist. The services detailed below were provided in accordance with the ethical guidelines of the Medical Council of Sri Lanka and the Royal College of Psychiatrists.
The patient attended the clinic for a comprehensive psychiatric evaluation and ongoing therapeutic management. The Psychiatrist conducted a detailed clinical interview, psychological assessment, and diagnostic formulation. Given the specialized nature of psychiatric care in Sri Lanka Colombo, the consultation included a review of medical history, current psychosocial stressors, and medication management. The clinic adheres to strict confidentiality protocols as mandated by Sri Lankan health regulations.
This document serves as an official financial record for the patient and may be submitted to insurance providers or corporate wellness programs for reimbursement. All fees are quoted in Sri Lankan Rupees (LKR) and are inclusive of applicable taxes unless otherwise stated.
| # | Description of Psychiatric Services | Date | Qty | Unit Price (LKR) | Total (LKR) |
|---|---|---|---|---|---|
| 1 |
Initial Comprehensive Psychiatric Consultation First-time assessment by Consultant Psychiatrist including diagnostic evaluation, mental status examination, and treatment planning. Conducted at Colombo Mind & Wellness Clinic, Colombo 03. |
Oct 10, 2023 | 1 | 15,000.00 | 15,000.00 |
| 2 |
Follow-up Psychiatric Therapy Session 45-minute individual psychotherapy session focusing on cognitive-behavioral strategies and medication adherence. Provided by Dr. Nimali Fernando. |
Oct 17, 2023 | 1 | 10,000.00 | 10,000.00 |
| 3 |
Psychological Assessment Battery Administration and interpretation of standardized psychological tests (e.g., PHQ-9, GAD-7, MMPI) to aid in psychiatric diagnosis. |
Oct 10, 2023 | 1 | 8,500.00 | 8,500.00 |
| 4 |
Family Consultation Session Joint session with patient and family members to discuss care plan, psychoeducation, and support strategies. Held at Colombo clinic premises. |
Oct 20, 2023 | 1 | 12,000.00 | 12,000.00 |
| 5 |
Medical Report & Certificate Issuance Official psychiatric medical report and fitness certificate for employer/insurance purposes, stamped by the clinic. |
Oct 22, 2023 | 1 | 3,500.00 | 3,500.00 |
Payment Instructions
Please make payment within 14 days of the invoice date. Payments can be made via bank transfer, cash, or credit card at the clinic reception in Colombo.
Bank Name: Commercial Bank of Ceylon PLC
Branch: Colombo Fort Main Branch
Account Name: Colombo Mind & Wellness Clinic (Pvt) Ltd
Account Number: 1234-5678-9012-3456
SWIFT Code: COMB LK CX
Reference: Please use Invoice Number INV-2023-0892 as payment reference.
Terms & Conditions
- All services are provided by licensed psychiatrists registered with the Medical Council of Sri Lanka.
- This invoice is valid for payment within 30 days. Late payments may incur a 2% monthly interest charge.
- Confidentiality of patient information is maintained in accordance with Sri Lankan data protection laws.
- Insurance claims should be submitted with this invoice and the detailed medical report.
- For any discrepancies, please contact our billing department within 7 days of receiving this invoice.
- Cash payments are accepted in Sri Lankan Rupees (LKR) only at the Colombo clinic.
Authorized Signature
Dr. Nimali FernandoConsultant Psychiatrist
Colombo Mind & Wellness Clinic ⬇️ Download as DOCX Edit online as DOCX
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