Invoice Psychiatrist in Vietnam Ho Chi Minh City –Free Word Template Download with AI
Specialized Psychiatry & Mental Health Services
123 Nguyen Hue Boulevard, District 1
Ho Chi Minh City, Vietnam
Tax Code (MST): 0312345678
Phone: +84 28 3822 1234 | Email: [email protected]
Invoice Number: INV-2023-10-089
Date of Issue: October 24, 2023
Due Date: November 07, 2023
Bill To:
Mr. Nguyen Van A
45 Le Loi Street, Ward 1
District 1, Ho Chi Minh City
Vietnam
Email: [email protected]
Service Description: This invoice covers professional psychiatric consultation, diagnostic assessment, and therapeutic sessions provided by a licensed Psychiatrist at our Ho Chi Minh City facility. The services rendered are in accordance with the medical standards of Vietnam and international best practices for mental health care.| # | Description of Services | Quantity / Hours | Unit Price (VND) | Total (VND) |
|---|---|---|---|---|
| 1 |
Initial Psychiatric Evaluation Comprehensive diagnostic interview conducted by the Psychiatrist to assess mental health status, medical history, and current symptoms. Includes formulation of a preliminary treatment plan. |
1 Session | 2,500,000 | 2,500,000 |
| 2 |
Psychopharmacological Management Prescription and management of medication tailored to the patient's specific condition. Includes dosage adjustment consultation and monitoring for side effects. |
1 Service | 1,200,000 | 1,200,000 |
| 3 |
Cognitive Behavioral Therapy (CBT) Session One-on-one therapeutic session focusing on identifying and changing negative thought patterns. Conducted by the attending Psychiatrist. |
3 Sessions | 1,800,000 | 5,400,000 |
| 4 |
Psychological Testing & Assessment Administration and interpretation of standardized psychological tests (e.g., MMPI, Beck Depression Inventory) to aid in accurate diagnosis. |
1 Set | 3,000,000 | 3,000,000 |
| 5 |
Follow-up Consultation Routine check-up to monitor progress, review medication efficacy, and adjust the treatment plan as necessary. |
2 Sessions | 1,500,000 | 3,000,000 |
| 6 |
Medical Report Generation Detailed clinical report summarizing the diagnosis, treatment history, and prognosis for insurance or personal records. |
1 Report | 800,000 | 800,000 |
(Sixteen Million Nine Hundred Ninety Thousand Vietnamese Dong)
Payment Terms & Conditions:
- Payment is due within 14 days of the invoice date.
- Late payments may incur a penalty fee of 1.5% per month on the outstanding balance.
- Please include the Invoice Number (INV-2023-10-089) as the reference for all bank transfers.
- This invoice is valid for insurance reimbursement claims in Vietnam.
Bank Transfer Details:
Bank Name: Vietcombank
Branch: District 1, Ho Chi Minh City
Account Name: Saigon Mind & Wellness Clinic Co., Ltd
Account Number: 0071001234567
SWIFT Code: BFTVVNVX
Authorized Signature
Dr. Tran Thi B
Lead Psychiatrist
Received By
__________________________
Date: ____________________
⬇️ Download as DOCX Edit online as DOCXCreate your own Word template with our GoGPT AI prompt:
GoGPT