Invoice Psychiatrist in Tanzania Dar es Salaam –Free Word Template Download with AI
Dr. Juma M. Mwangi, MBChB, FCPS (Psychiatry)
Plot No. 45, Sam Nujoma Road
Mikocheni, Dar es Salaam, Tanzania
Tel: +255 22 211 5500 | Mobile: +255 754 123 456
Email: [email protected]
TIN: 123-456-789-00-000
Invoice Number: INV-2023-PSY-0892
Date of Issue: October 24, 2023
Due Date: November 07, 2023
Payment Terms: Net 14 Days
Bill To:
Client Name: Ms. Amina K. Hassan
Address: House No. 12, Msasani Peninsula, Dar es Salaam, Tanzania
Phone: +255 712 987 654
Email: [email protected]
Insurance Provider (if applicable): Jubilee Health Insurance Ltd.
Policy Number: JHI-987654321
| # | Description of Psychiatric Services | Date | Qty | Unit Price (TZS) | Total (TZS) |
|---|---|---|---|---|---|
| 1 | Initial Comprehensive Psychiatric Evaluation and Diagnostic Assessment | Oct 10, 2023 | 1 | 150,000 | 150,000 |
| 2 | Individual Cognitive Behavioral Therapy (CBT) Session (60 mins) | Oct 17, 2023 | 1 | 100,000 | 100,000 |
| 3 | Medication Management and Prescription Review Consultation | Oct 24, 2023 | 1 | 80,000 | 80,000 |
| 4 | Psychological Testing Battery (Anxiety & Depression Scales) | Oct 10, 2023 | 1 | 120,000 | 120,000 |
| 5 | Family Psychoeducation Session (90 mins) | Oct 21, 2023 | 1 | 130,000 | 130,000 |
Amount in words: Six Hundred Sixty-Four Thousand Four Hundred Tanzanian Shillings only.
Payment Instructions
Please make payment within 14 days of the invoice date to avoid late fees. Payments can be made via the following methods:
- Bank Transfer: CRDB Bank, Branch: Mikocheni, Account Name: Dar es Salaam Mental Health & Psychiatry Clinic, Account Number: 0123456789012
- M-Pesa / Tigo Pesa: +255 754 123 456 (Dr. Juma M. Mwangi)
- Cash: Accepted at the clinic reception during business hours (Monday-Friday, 8:00 AM - 5:00 PM).
Reference: Please use Invoice Number INV-2023-PSY-0892 as payment reference.
Important Notes & Terms:
1. This invoice is issued in accordance with the regulations of the Tanzania Revenue Authority (TRA) and the Medical and Dental Practitioners Council of Tanzania (MDPCT).
2. All psychiatric services rendered are confidential and protected under Tanzanian medical privacy laws.
3. Late payments will incur a penalty of 2% per month on the outstanding balance.
4. Insurance claims should be submitted directly by the patient or through our billing department within 30 days of service.
5. For any queries regarding this invoice, please contact our billing office at [email protected] or call +255 22 211 5500.
6. This document serves as an official receipt upon confirmation of payment.
7. The psychiatrist reserves the right to adjust fees based on the complexity of the case and additional diagnostic requirements.
8. All prices are inclusive of professional fees but exclude medication costs unless otherwise stated.
Authorized Signature:
Dr. Juma M. Mwangi
Lead Psychiatrist
Received By (Client):
_________________________
Date: ___________________
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