Invoice Radiologist in Brazil Rio de Janeiro –Free Word Template Download with AI
Specialized Diagnostic Imaging Services
Av. Atlântica, 1702, Copacabana
Rio de Janeiro, RJ - 22021-001
Brazil
CNPJ: 12.345.678/0001-90
Phone: +55 (21) 3333-4444
Email: [email protected]
Invoice Number: INV-2023-10-045
Date of Issue: October 24, 2023
Due Date: November 07, 2023
Service Period: October 2023
Bill To (Client Information)Client Name: Hospital Santa Casa de Misericórdia
Address: Rua da Misericórdia, 1, Centro
City/State/Zip: Rio de Janeiro, RJ - 20261-080
Country: Brazil
Attn: Procurement Department / Dr. Carlos Mendes
Contact Email: [email protected]
Service Provider (Radiologist Details)Radiologist Name: Dr. Eduardo Silva, M.D.
Specialty: Diagnostic Radiology & Interventional Radiology
CRM-RJ License: 78.901
RQE-RJ License: 12.345
Affiliation: Rio Radiology Center
Role: Senior Staff Radiologist providing interpretation and reporting services.
Description of Services Rendered| Item | Description of Radiological Services | Quantity | Unit Price (BRL) | Total (BRL) |
|---|---|---|---|---|
| 1 |
CT Scan Interpretation (Head & Neck) Detailed analysis and reporting of Computed Tomography scans performed at Rio Radiology Center. Includes assessment for trauma, stroke, and neoplastic conditions. Performed by Dr. Eduardo Silva in accordance with Brazilian Society of Radiology standards. |
15 | R$ 150.00 | R$ 2,250.00 |
| 2 |
MRI Interpretation (Lumbar Spine) Comprehensive review of Magnetic Resonance Imaging studies focusing on the lumbar region. Evaluation of disc herniation, spinal stenosis, and nerve root compression. Reports delivered within 24 hours of image acquisition. |
10 | R$ 200.00 | R$ 2,000.00 |
| 3 |
Mammography Screening & Diagnostic Review Interpretation of bilateral mammograms including BI-RADS classification. Consultation with referring physicians regarding suspicious findings. Adherence to Rio de Janeiro state health regulations for breast cancer screening. |
20 | R$ 120.00 | R$ 2,400.00 |
| 4 |
Ultrasound Abdomen & Pelvis Reporting Real-time interpretation of abdominal and pelvic ultrasound examinations. Assessment of liver, kidneys, gallbladder, and reproductive organs. Includes Doppler flow analysis where applicable. |
25 | R$ 100.00 | R$ 2,500.00 |
| 5 |
Interventional Radiology Procedure (Biopsy) Image-guided core needle biopsy of thyroid nodule. Includes pre-procedure planning, sterile technique execution, and post-procedure care instructions. Performed at Rio Radiology Center facility. |
5 | R$ 800.00 | R$ 4,000.00 |
| 6 |
Emergency Radiology Coverage (On-Call) Availability for urgent case interpretation during off-hours (nights and weekends). Includes immediate reporting for critical findings such as pulmonary embolism or intracranial hemorrhage. |
1 | R$ 1,500.00 | R$ 1,500.00 |
| Subtotal: | R$ 14,650.00 |
| Discounts: | R$ 0.00 |
| Taxes (ISS - Rio de Janeiro): | R$ 732.50 |
| TOTAL DUE: | R$ 15,382.50 |
Amount in words: Fifteen thousand, three hundred and eighty-two Brazilian Reais and fifty cents.
Payment InstructionsBank: Banco do Brasil
Agency: 1234-5
Account Number: 98765-4
Account Holder: Rio Radiology Center Ltda
PIX Key: [email protected]
Reference: Please cite Invoice Number INV-2023-10-045 in the payment description.
Payment Terms: Net 14 days from the date of invoice. Late payments may incur a penalty of 2% plus interest of 1% per month.
Terms and Conditions
- All services described in this invoice were performed by a licensed Radiologist in Rio de Janeiro, Brazil, in compliance with the Federal Council of Medicine (CFM) regulations.
- The prices listed are in Brazilian Reais (BRL) and include applicable service fees. Taxes are calculated according to Rio de Janeiro municipal laws.
- Reports generated by the Radiologist are confidential and intended solely for the use of the referring physician and the patient.
- Any disputes regarding the quality or accuracy of the radiological interpretation must be raised within 30 days of the invoice date.
- This invoice serves as a formal request for payment for professional medical services rendered. Failure to pay by the due date may result in suspension of future services.
- Rio Radiology Center reserves the right to adjust fees annually based on market conditions and inflation rates in Brazil.
Authorized Signature (Provider)
Dr. Eduardo Silva, M.D.
Radiologist
Received By (Client)
__________________________
Date: ____________________
This document is an official invoice issued by Rio Radiology Center, located in Rio de Janeiro, Brazil. The services provided are performed by qualified medical professionals specializing in radiology. All interpretations are based on current medical standards and guidelines. For any questions regarding this invoice, please contact our billing department at [email protected] or call +55 (21) 3333-4444. We appreciate your business and trust in our radiological expertise.
© 2023 Rio Radiology Center. All rights reserved.
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