Invoice Radiologist in India Bangalore –Free Word Template Download with AI
Lead Radiologist: Dr. Arjun Mehta, MD (Radiology), DNB
123, MG Road, Indiranagar
Bangalore, Karnataka - 560038
India
Email: [email protected]
Phone: +91 80 4567 8900
GSTIN: 29ABCDE1234F1Z5
Invoice Number: INV-BLR-2023-0892
Date of Issue: October 24, 2023
Due Date: November 07, 2023
Service Period: October 2023
Bill To (Client/Patient)Name: Mr. Rajesh Kumar
Address: 45, Koramangala 4th Block, Bangalore, Karnataka - 560034, India
Contact: +91 98765 43210
Email: [email protected]
Patient ID: PAT-88291
Description of Radiological ServicesThis invoice details the professional fees charged by the Lead Radiologist for the interpretation and reporting of diagnostic imaging procedures performed at our facility in Bangalore, India. The services include advanced analysis of MRI, CT, and X-Ray scans, ensuring high diagnostic accuracy in accordance with Indian medical standards.
| # | Description of Service | Date | Quantity | Amount (INR) |
|---|---|---|---|---|
| 1 |
MRI Brain with Contrast Professional fee for radiological interpretation by Dr. Arjun Mehta. Detailed analysis of cranial structures. |
Oct 10, 2023 | 1 | ₹ 4,500.00 |
| 2 |
CT Scan Chest (High Resolution) Interpretation of thoracic imaging. Evaluation of lung parenchyma and mediastinal structures. |
Oct 12, 2023 | 1 | ₹ 3,800.00 |
| 3 |
MRI Lumbar Spine Radiologist's professional fee for assessing spinal cord, nerve roots, and intervertebral discs. |
Oct 15, 2023 | 1 | ₹ 4,200.00 |
| 4 |
Ultrasound Abdomen (Complete) Real-time imaging interpretation of abdominal organs including liver, gallbladder, and kidneys. |
Oct 18, 2023 | 1 | ₹ 1,500.00 |
| 5 |
Consultation Fee (Radiology) Direct consultation with the Radiologist to discuss complex findings and treatment recommendations. |
Oct 20, 2023 | 1 | ₹ 1,000.00 |
Please make the payment within 14 days of the invoice date. Payments can be made via the following methods:
- Bank Transfer (NEFT/RTGS):
Bank Name: HDFC Bank
Account Name: Advanced Imaging & Diagnostics Pvt Ltd
Account Number: 50200012345678
IFSC Code: HDFC0001234
Branch: Indiranagar, Bangalore, India - UPI: advancedimagingblr@hdfc
- Cheque: Payable to "Advanced Imaging & Diagnostics Pvt Ltd"
Note: Please quote the Invoice Number (INV-BLR-2023-0892) in the payment remarks.
Terms and Conditions- Validity: This invoice is valid for 30 days from the date of issue. Late payments may incur a penalty of 2% per month.
- Disputes: Any discrepancies regarding the services provided by the Radiologist must be reported within 7 days of receiving this invoice.
- Confidentiality: All patient data and medical reports are handled in strict accordance with the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations.
- Jurisdiction: This agreement is subject to the laws of India, and any legal disputes will be settled in the courts of Bangalore, Karnataka.
- Insurance: If you have health insurance, please submit this invoice along with the diagnostic reports to your provider for reimbursement.
Thank you for choosing our Radiology services in Bangalore.
Authorized Signatory
Dr. Arjun Mehta
Lead Radiologist
Received By
Name: ____________________
Date: ____________________
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