Invoice Radiologist in Chile Santiago –Free Word Template Download with AI
Specialized Diagnostic Radiology Services
Av. Providencia 1234, Oficina 501
Providencia, Santiago, Chile
Phone: +56 2 2345 6789
Email: [email protected]
RUT: 76.543.210-K
Invoice Number: INV-2023-10-045
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Payment Terms: Net 30 Days
Bill To:
Clínica Las Condes
Department of Medical Imaging
Av. Kennedy 5454
Las Condes, Santiago, Chile
RUT: 96.789.012-3
Attn: Dr. Roberto Méndez, Chief of Radiology
Service Provider (Radiologist):
Dr. Elena Soto, MD, PhD
Board-Certified Diagnostic Radiologist
Specialization: Neuroradiology and Musculoskeletal Imaging
Medical License No: 12345678 (Colegio Médico de Chile)
| Description of Services | Quantity | Unit Price (CLP) | Total (CLP) |
|---|---|---|---|
|
Professional Radiology Consultation & Interpretation Comprehensive analysis of MRI scans for lumbar spine pathology. Includes detailed written report delivered within 24 hours, adhering to Chilean medical standards. |
1 | 150.000 | 150.000 |
|
CT Scan Interpretation (Thorax & Abdomen) Detailed radiological assessment of contrast-enhanced CT images. Evaluation for pulmonary nodules and abdominal organ integrity. |
3 | 120.000 | 360.000 |
|
Urgent Teleradiology Service Emergency interpretation of cranial CT scans for trauma patients at Santiago facilities. Priority handling within 1 hour of image upload. |
5 | 180.000 | 900.000 |
|
Mammography Screening Review BI-RADS classification and diagnostic review of digital mammography images for preventive care patients. |
10 | 85.000 | 850.000 |
|
Second Opinion Consultation Expert review of complex oncological imaging cases. Includes teleconference with referring physician in Santiago. |
2 | 250.000 | 500.000 |
Payment Instructions:
Please remit payment via bank transfer to the following account:
Bank: Banco de Chile
Account Name: Advanced Imaging Radiology Center SpA
Account Number: 1234567890123
CLABE: 715000123456789012
Please include the Invoice Number (INV-2023-10-045) as the reference for the transfer.
Terms and Conditions:
1. This invoice represents professional services rendered by a licensed Radiologist operating within the jurisdiction of Santiago, Chile.
2. Payment is due within 30 days of the invoice date. Late payments may incur a penalty of 1.5% per month.
3. All diagnostic reports are confidential and protected under Chilean data privacy laws (Ley 19.628).
4. In case of discrepancies, please contact our billing department within 15 days of receiving this invoice.
5. This document serves as a formal request for payment for medical imaging interpretation services provided during the period of October 1, 2023, to October 31, 2023.
Advanced Imaging Radiology Center is a registered medical service provider in Chile. Our radiologists are certified by the Chilean Medical College and adhere to the highest standards of diagnostic accuracy and patient care. This invoice is issued in accordance with the tax regulations of the Servicio de Impuestos Internos (SII) of Chile. The services described herein include the professional expertise required to interpret complex medical imaging, ensuring accurate diagnoses for patients in Santiago and surrounding regions. We appreciate your business and trust in our radiological services.
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