Invoice Psychiatrist in United Arab Emirates Abu Dhabi –Free Word Template Download with AI

Bill To:

Patient Name: Mr. Ahmed Al-Mansoori
Insurance Provider: Daman Insurance Company
Policy Number: DAM-99887766
Group ID: GRP-554433
Address: Yas Island, Abu Dhabi, UAE
Contact: +971 50 123 4567

Invoice Details:

Invoice Number:	INV-2023-10-0045
Date of Issue:	October 24, 2023
Date of Service:	October 20, 2023
Due Date:	November 24, 2023
Attending Psychiatrist:	Dr. Sarah Johnson, MD

Description of Services	Code	Qty	Unit Price (AED)	Total (AED)
Initial Psychiatric Evaluation Comprehensive assessment including clinical history, mental status examination, and diagnostic formulation conducted by a board-certified Psychiatrist in Abu Dhabi.	90791	1	850.00	850.00
Psychiatric Follow-up Consultation Medication management review and therapeutic progress evaluation session.	90792	1	550.00	550.00
Psychological Testing Administration Administration and scoring of standardized cognitive and mood assessment tools.	96130	1	400.00	400.00
Medical Report Generation Detailed clinical summary for insurance and occupational health purposes compliant with UAE regulations.	99024	1	250.00	250.00

Subtotal: 2,050.00 AED VAT (5%): 102.50 AED Insurance Coverage: -1,800.00 AED Amount Due: 352.50 AED

Important Notes & Terms:

This Invoice represents services rendered by a licensed Psychiatrist operating under the regulations of the Department of Health – Abu Dhabi (DoH). All medical services provided at the Abu Dhabi Advanced Psychiatry Center adhere to the highest standards of clinical care and patient confidentiality mandated by the United Arab Emirates healthcare authority.

Payment Terms: Payment is due within 30 days of the invoice date. For insurance claims, please submit this document along with the patient's ID copy and medical report to your respective insurer. Late payments may incur a service fee as per UAE commercial law.

VAT Information: Value Added Tax is applied at the standard rate of 5% in accordance with the Federal Tax Authority (FTA) of the United Arab Emirates. Our TRN is: 100 234 567 891 000.

Privacy Policy: Patient data shared via this invoice is protected under UAE Federal Decree-Law No. 45 of 2021 on the Protection of Personal Data.

Authorized Signature

Dr. Sarah Johnson
Lead Psychiatrist
Abu Dhabi Advanced Psychiatry Center ⬇️ Download as DOCX Edit online as DOCX

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