Invoice Psychiatrist in Uzbekistan Tashkent –Free Word Template Download with AI
Department of Psychiatry & Psychotherapy
Address: 100000, Tashkent City, Amir Temur Avenue, Building 45
Phone: +998 (71) 200-00-00
Email: [email protected]
TIN (Tax ID): 123456789
Invoice #: INV-2023-PSY-8842
Date: October 24, 2023
Due Date: November 07, 2023
Payment Terms: Net 14
Bill To:
Mr. Azamat Karimov
Residential Address: Yunusabad District, Tashkent, Uzbekistan
Insurance Provider: UzMedLife Insurance JSC
Policy Number: UZ-998-55421
| # | Description of Psychiatric Services | Date of Service | Quantity | Unit Price (UZS) | Total (UZS) |
|---|---|---|---|---|---|
| 1 |
Initial Comprehensive Psychiatric Evaluation Detailed clinical interview conducted by a licensed Psychiatrist in Tashkent. Includes assessment of mental status, medical history review, and diagnostic formulation according to ICD-11 standards. |
Oct 10, 2023 | 1 | 850,000 | 850,000 |
| 2 |
Psychopharmacological Management Session Medication review and adjustment session. The Psychiatrist evaluated the efficacy of current treatment protocols and prescribed necessary adjustments for mood stabilization. |
Oct 17, 2023 | 1 | 600,000 | 600,000 |
| 3 |
Cognitive Behavioral Therapy (CBT) - Individual 60-minute therapeutic session focused on cognitive restructuring and behavioral activation techniques tailored for the patient's specific anxiety profile. |
Oct 17, 2023 | 1 | 550,000 | 550,000 |
| 4 |
Psychological Testing & Assessment Battery Administration and scoring of standardized psychological tests (Beck Depression Inventory, GAD-7) to quantify symptom severity and track progress. |
Oct 10, 2023 | 1 | 400,000 | 400,000 |
| 5 |
Family Consultation Session Consultation with immediate family members to provide psychoeducation regarding the diagnosis and establish a supportive home environment in accordance with local cultural norms. |
Oct 20, 2023 | 1 | 700,000 | 700,000 |
Payment Instructions & Notes
Please remit payment in Uzbekistan Sum (UZS) via bank transfer to the account listed below. This Invoice serves as the official financial record for the psychiatric care provided in Tashkent. All services were rendered by board-certified Psychiatrists adhering to the Ministry of Health of the Republic of Uzbekistan guidelines.
Bank Details:
Bank Name: Ipak Yuli Bank
Account Name: Tashkent Mental Health Institute LLC
IBAN: UZ99 IPAK 0000 1234 5678 9000
SWIFT: IPAKUZ2X
If you have any questions regarding this Invoice or the psychiatric services rendered, please contact our billing department immediately. Late payments may incur a penalty fee as per the regulations of Uzbekistan.
Terms and Conditions: This document constitutes a formal Invoice for medical services provided by a licensed Psychiatrist. The services described herein were performed at our facility in Tashkent, Uzbekistan. The patient acknowledges receipt of these services. Confidentiality of all medical information contained within this Invoice is protected under the laws of the Republic of Uzbekistan. This Invoice is valid for tax deduction purposes. Please retain this document for your personal records and insurance claims. Any disputes regarding the charges must be raised within 30 days of the Invoice date. The Psychiatrist reserves the right to suspend further treatment if payment terms are not met. This Invoice reflects the standard rates for psychiatric care in Tashkent for the current fiscal year.
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