Invoice Radiologist in France Paris –Free Word Template Download with AI
Dr. Jean-Pierre Dubois, MD, PhD
Board-Certified Radiologist
15 Avenue de la République
75011 Paris, France
Tel: +33 1 42 77 88 99
Email: [email protected]
SIRET: 823 456 789 00012 | TVA Intracommunautaire: FR 12 823456789
RPPS: 10004751112
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 Européen Georges-Pompidou
Service de Facturation Médicale
20 Rue Leblanc
75015 Paris, France
Attention: Mme. Sophie Martin
Service Details:
Patient Name: Marie Curie
Date of Service: October 20, 2023
Referring Physician: Dr. Antoine Moreau
Insurance Provider: CPAM Paris (Sécurité Sociale)
Complementary Insurance: Mutuelle Santé Plus
| # | Description of Radiological Services | CCAM Code | Qty | Unit Price (€) | Total (€) |
|---|---|---|---|---|---|
| 1 |
Magnetic Resonance Imaging (MRI) of the Brain High-resolution neuro-imaging without contrast. Includes detailed analysis by a senior radiologist specializing in neuroradiology. Performed at our Parisian clinic using 3.0 Tesla technology. |
FGCA001 | 1 | 250.00 | 250.00 |
| 2 |
Computed Tomography (CT Scan) of the Chest Low-dose spiral CT scan for pulmonary evaluation. Includes reconstruction of images in axial, coronal, and sagittal planes. Interpretation report provided within 24 hours. |
FGCA002 | 1 | 180.00 | 180.00 |
| 3 |
Ultrasound Examination of the Abdomen Comprehensive abdominal ultrasound including liver, gallbladder, pancreas, spleen, and kidneys. Performed by a certified radiologist in accordance with French medical standards. |
FGCA003 | 1 | 95.00 | 95.00 |
| 4 |
Contrast Media Administration Intravenous injection of iodinated contrast agent for CT scan enhancement. Includes pre-procedure allergy screening and post-procedure monitoring. |
FGCA004 | 1 | 45.00 | 45.00 |
| 5 |
Specialized Radiological Report Comprehensive written report detailing findings from all imaging procedures. Includes differential diagnosis suggestions and recommendations for further clinical management. |
FGCA005 | 1 | 120.00 | 120.00 |
| 6 |
Image Storage and Digital Transfer Secure storage of DICOM images for 5 years as required by French law. Digital transfer of images to referring physician via secure HL7/FHIR compliant platform. |
FGCA006 | 1 | 30.00 | 30.00 |
| Subtotal: | 720.00 € |
| VAT (20%): | 144.00 € |
| TOTAL AMOUNT DUE: | 864.00 € |
Payment Instructions & Notes
Bank Transfer Details:
Bank: Société Générale Paris
IBAN: FR76 3000 1000 0112 3456 7890 189
BIC: SOGEFRPP
Reference: INV-2023-10-045
Please note that this invoice is issued in accordance with French medical billing regulations. All services were performed by qualified radiologists at our facility in Paris, France. The CCAM codes listed correspond to the official French medical nomenclature for radiological procedures.
Payment is due within 30 days of the invoice date. Late payments may incur a penalty of 3 times the legal interest rate plus a fixed recovery fee of 40 euros, as stipulated by French law (Article L441-6 of the Commercial Code).
For any questions regarding this invoice or the radiological services provided, please contact our billing department at +33 1 42 77 88 99 or email [email protected]. Our office is located in the heart of Paris and is open Monday through Friday from 8:00 AM to 6:00 PM.
This document serves as an official record of radiological services rendered. All patient data has been handled in strict compliance with the French Data Protection Act (Loi Informatique et Libertés) and the General Data Protection Regulation (GDPR).
Authorized SignatureDr. Jean-Pierre Dubois
Lead Radiologist Received By
_________________________
Date: ____________________ ⬇️ Download as DOCX Edit online as DOCX
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