Invoice Radiologist in India New Delhi –Free Word Template Download with AI
Lead Radiologist: Dr. Rajesh Kumar, MD (Radiology), FRCR
14, Institutional Area, Sector 62, Noida Extension
New Delhi, India - 110001
Phone: +91-11-4567-8900 | Email: [email protected]
GSTIN: 07AABCD1234E1Z5
Invoice #: DL-2023-8942
Date: October 24, 2023
Due Date: November 07, 2023
Bill To:
Max Healthcare Institute Ltd.
102, Safdarjung Enclave
New Delhi, India - 110029
Attn: Accounts Payable Department
GSTIN: 07AAACM1234F1Z9
| Description of Radiological Services | HSN/SAC Code | Qty | Rate (INR) | Amount (INR) |
|---|---|---|---|---|
|
Professional Fee - Radiologist Interpretation Comprehensive analysis of MRI Brain with Gadolinium contrast. Includes detailed reporting of intracranial structures, vascular assessment, and correlation with clinical history provided by the referring neurologist. |
999411 | 1 | 4,500.00 | 4,500.00 |
|
Technical Fee - MRI Scan (1.5 Tesla) Utilization of high-field magnetic resonance imaging equipment located at our New Delhi facility. Includes patient positioning, sequence optimization (T1, T2, FLAIR, DWI), and contrast administration monitoring. |
999411 | 1 | 8,000.00 | 8,000.00 |
|
Contrast Media (Gadobutrol 1ml) Intravenous administration of MRI contrast agent to enhance visualization of soft tissue abnormalities and blood-brain barrier integrity. |
300490 | 1 | 1,200.00 | 1,200.00 |
|
Urgent Reporting Surcharge Expedited review and finalization of the radiology report within 2 hours of scan completion, as requested for emergency neurological assessment. |
999411 | 1 | 1,500.00 | 1,500.00 |
|
Digital Image Transfer & Storage Secure DICOM transfer of images to referring hospital PACS system and cloud-based archival for 5 years as per Indian medical data retention standards. |
998314 | 1 | 500.00 | 500.00 |
Terms and Conditions & Payment Instructions:
1. Payment Terms: Payment is due within 15 days of the invoice date. Late payments may incur a penalty of 1.5% per month on the outstanding balance.
2. Bank Details: Please make payments via NEFT/RTGS to the following account:
Bank Name: State Bank of India
Branch: Connaught Place, New Delhi
Account Name: Delhi Advanced Imaging & Radiology Center Pvt. Ltd.
Account Number: 30512345678
IFSC Code: SBIN0001234
3. Radiologist Liability: The interpretation provided by the Lead Radiologist is based on the images acquired at the time of the examination. This invoice covers the professional service of interpretation and technical execution only. It does not constitute a guarantee of future health outcomes. 4. Disputes: Any discrepancies regarding this invoice must be reported within 7 days of receipt. All legal matters related to this transaction shall be subject to the jurisdiction of the courts in New Delhi, India. 5. Tax Compliance: This invoice is generated in compliance with the Goods and Services Tax (GST) laws of India. The HSN/SAC codes provided are accurate for the services rendered.
Thank you for choosing our radiology services in New Delhi. We are committed to providing accurate diagnostic imaging to support patient care across India.
Authorized SignatoryAccounts Department Dr. Rajesh Kumar
Lead Radiologist
MD, FRCR ⬇️ Download as DOCX Edit online as DOCX
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