Invoice Psychiatrist in Turkey Ankara –Free Word Template Download with AI
Dr. Elif Yilmaz, M.D., Ph.D.
Board Certified Psychiatrist
Kızılay Mahallesi, Atatürk Bulvarı No: 123
Çankaya, 06420 Ankara, Turkey
Tax ID (Vergi No): 123 456 78 90
Tax Office (Vergi Dairesi): Çankaya
Email: [email protected]
Phone: +90 (312) 555 0199
Invoice Number: INV-ANK-2023-0892
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Service Period: October 1, 2023 - October 24, 2023
Bill To:
Mr. Ahmet Demir
Residence: Kavaklıdere Mahallesi, Çiçek Sokak No: 45/D
06680 Çankaya, Ankara, Turkey
Tax ID: 987 654 32 10
Insurance / Payer Details:
Private Health Insurance Co.
Policy Number: POL-TR-998877
Group ID: GRP-ANK-55
Reference Code: REF-PSY-2023
| # | Description of Psychiatric Services | Date | Qty | Unit Price (TRY) | Total (TRY) |
|---|---|---|---|---|---|
| 1 |
Initial Psychiatric Evaluation & Diagnosis Comprehensive clinical interview, mental status examination, and diagnostic assessment conducted in accordance with DSM-5-TR standards. Includes review of medical history and formulation of a preliminary treatment plan. |
Oct 02 | 1 | 2,500.00 | 2,500.00 |
| 2 |
Psychopharmacological Management Session Follow-up consultation for medication review, dosage adjustment, and monitoring of therapeutic response and side effects. Includes prescription issuance valid within the Republic of Turkey. |
Oct 09 | 1 | 1,800.00 | 1,800.00 |
| 3 |
Cognitive Behavioral Therapy (CBT) - Individual 60-minute individual psychotherapy session focusing on cognitive restructuring and behavioral activation techniques tailored for anxiety management. |
Oct 12 | 1 | 2,000.00 | 2,000.00 |
| 4 |
Psychological Testing & Neuropsychological Assessment Administration and scoring of standardized psychological tests (e.g., Beck Depression Inventory, Hamilton Anxiety Rating Scale) to quantify symptom severity and guide clinical decision-making. |
Oct 16 | 1 | 3,200.00 | 3,200.00 |
| 5 |
Family Psychoeducation Session Consultation with immediate family members to provide education regarding the patient's condition, treatment adherence, and supportive care strategies within the household environment. |
Oct 20 | 1 | 2,200.00 | 2,200.00 |
| 6 |
Medical Report & Certification Preparation of a detailed clinical report for insurance purposes and official medical leave certification, compliant with Turkish Ministry of Health regulations. |
Oct 24 | 1 | 750.00 | 750.00 |
Payment Terms and Banking Information
Payment is due within 30 days of the invoice date. Please make payments via bank transfer to the following account located in Ankara, Turkey:
Bank Name: Ziraat Bankası A.Ş.
Branch: Çankaya Merkez
Account Name: Ankara Advanced Psychiatry Center
IBAN: TR12 0001 0001 2345 6789 0123 45
SWIFT/BIC: TCBATRIS
Please reference the Invoice Number (INV-ANK-2023-0892) in the payment description. For credit card payments, please contact our billing department directly. Late payments may incur a penalty interest rate as per Turkish Commercial Code regulations.
Important Notes Regarding Psychiatric Services
This invoice reflects professional psychiatric services rendered by a licensed medical doctor in the Republic of Turkey. All treatments provided adhere to the ethical guidelines set forth by the Turkish Psychiatric Association and the Ministry of Health.
Confidentiality: Patient information contained within this invoice and associated medical records is strictly confidential and protected under Turkish Law No. 6698 on the Protection of Personal Data (KVKK). Disclosure of this information to third parties without consent is prohibited, except as required by law or insurance processing.
Validity: This invoice is valid for tax purposes in Turkey. It serves as an official receipt for the services described. Please retain this document for your personal records and insurance reimbursement claims.
Emergency Contact: In case of a psychiatric emergency, please do not rely on this billing contact. Instead, dial 112 for emergency medical services in Ankara or visit the nearest hospital emergency department immediately.
Authorized Signature
Dr. Elif Yilmaz, M.D.
Lead Psychiatrist
Received By (Patient)
Signature:
Date:
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