Invoice Radiologist in France Marseille –Free Word Template Download with AI
Centre de Radiologie Spécialisé
123 Boulevard Charles Livon
13007 Marseille, France
Tel: +33 4 91 00 00 00
Email: [email protected]
SIRET: 823 456 789 00012 | TVA Intracommunautaire: FR 12 823456789
Invoice Number: INV-2023-10-045
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Payment Terms: Net 30 Days
BILL TO:
Hôpital de la Timone
Direction des Soins
264 Rue Saint-Pierre
13385 Marseille Cedex 05, France
Attn: Dr. Jean-Pierre Dubois
RE: PATIENT SERVICES
Patient Name: Marie-Claire Laurent
Date of Service: October 20, 2023
Referring Physician: Dr. Sophie Martin
Insurance Reference: CPAM Bouches-du-Rhône
| # | Description of Radiological Services | Code (CCAM) | Qty | Unit Price (€) | Total (€) |
|---|---|---|---|---|---|
| 1 |
Magnetic Resonance Imaging (MRI) of the Lumbar Spine High-resolution imaging performed by a certified Radiologist to assess disc herniation and spinal stenosis. Includes contrast agent administration and detailed interpretation of results. |
FBPA001 | 1 | 350.00 | 350.00 |
| 2 |
Computed Tomography (CT Scan) of the Abdomen Cross-sectional imaging of the abdominal cavity. Performed at our Marseille facility using state-of-the-art 64-slice technology. Includes radiological report. |
FBPA002 | 1 | 280.00 | 280.00 |
| 3 |
Specialized Radiological Consultation Comprehensive review of imaging findings by a senior Radiologist. Discussion of diagnostic conclusions and recommendations for further treatment or follow-up. |
FBPA003 | 1 | 120.00 | 120.00 |
| 4 |
Ultrasound Examination of the Thyroid High-frequency ultrasound imaging to evaluate thyroid nodules. Includes Doppler flow analysis. |
FBPA004 | 1 | 95.00 | 95.00 |
| 5 |
Contrast Media and Consumables Iodinated contrast agent for CT scan and Gadolinium-based contrast agent for MRI. Includes intravenous access supplies. |
FBPA005 | 1 | 65.00 | 65.00 |
Terms and Conditions & Important Information
This Invoice represents the professional fees for radiological services rendered by a qualified Radiologist at Imagerie Médicale du Vieux-Port, located in the heart of France Marseille. All medical imaging procedures were conducted in strict accordance with French medical standards and regulations.
Payment Instructions: Please remit payment via bank transfer to the account details below. Checks should be made payable to "Imagerie Médicale du Vieux-Port". Late payments may incur a penalty interest rate of 3 times the legal rate, plus a fixed indemnity of 40 euros for recovery costs, in accordance with French law.
Bank Details:
Bank: BNP Paribas Marseille Centre
IBAN: FR76 3000 4000 0100 0000 0000 000
BIC: BNPAFRPP
Medical Disclaimer: The services described herein are for diagnostic purposes only. The Radiologist's report is based on the images acquired at the time of the examination. This Invoice does not constitute a guarantee of medical outcomes. Please contact our administrative office in Marseille if you have any questions regarding the billing codes or the services provided.
Data Protection: Your personal and medical data are processed in compliance with the GDPR and French data protection laws. They are used solely for billing and medical record-keeping purposes.
Authorized Signature
Dr. Antoine MoreauChief Radiologist
Imagerie Médicale du Vieux-Port ⬇️ Download as DOCX Edit online as DOCX
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