Invoice Radiologist in Iran Tehran –Free Word Template Download with AI
Specialized Radiology & Diagnostic Services
No. 45, Valiasr Street, Near Ferdowsi Square
Tehran, Iran
Tax ID (Shenaseh Melli): 10104589632
Phone: +98 21 2200 5500
Email: [email protected]
Invoice Number: INV-TR-2023-8842
Date of Issue: October 24, 2023
Due Date: November 07, 2023
Currency: Iranian Rial (IRR)
Bill To:
Dr. Sarah Ahmadi (Referring Physician)
Private Practice - Ahmadi Medical Clinic
No. 12, Enghelab Avenue, Tehran, Iran
Patient Name: Mr. Reza Karimi
Patient ID: 9876543210
This document serves as an official invoice for professional radiological services rendered by our certified radiologist team at Tehran Advanced Imaging Center. As a premier diagnostic facility located in the heart of Tehran, Iran, we are committed to providing high-precision imaging and expert interpretation. The following charges reflect the comprehensive analysis, technical execution, and reporting services provided in accordance with the medical standards of the Islamic Republic of Iran.
| Description of Service | Quantity | Unit Price (IRR) | Total (IRR) |
|---|---|---|---|
|
Consultation with Senior Radiologist Initial review of patient history and clinical requirements prior to imaging. |
1 | 1,500,000 | 1,500,000 |
|
MRI Scan (Brain & Cranial Nerves) - 3 Tesla High-resolution magnetic resonance imaging performed by certified technologists. Includes contrast agent administration. |
1 | 12,000,000 | 12,000,000 |
|
CT Scan (Chest & Abdomen) with Contrast Computed tomography for detailed cross-sectional imaging. |
1 | 8,500,000 | 8,500,000 |
|
Expert Radiologist Interpretation & Report Detailed diagnostic report written by a board-certified radiologist, including differential diagnosis and recommendations. |
2 | 2,000,000 | 4,000,000 |
|
Digital Image Archiving & Transfer (PACS) Secure storage and transfer of DICOM images to referring physician via Tehran Health Network. |
1 | 500,000 | 500,000 |
|
Urgent Service Fee Expedited processing and reporting within 4 hours. |
1 | 1,000,000 | 1,000,000 |
| Subtotal: | 27,500,000 IRR |
| Value Added Tax (VAT) - 10%: | 2,750,000 IRR |
| Total Amount Due: | 30,250,000 IRR |
Terms and Conditions:
- Payment is due within 14 days of the invoice date.
- All services were performed in compliance with the regulations of the Iranian Ministry of Health and Medical Education.
- The radiologist’s report is confidential and intended solely for the referring physician and patient.
- For insurance claims, please attach this invoice along with the official medical report.
- Bank Transfer Details: Bank Melli Iran, Branch: Valiasr, Account No: 1234567890, IBAN: IR1234567890123456789012.
Authorized by:
Dr. Ali Rezaei, MD, PhD
Chief Radiologist
Tehran Advanced Imaging Center
Received by:
_________________________
Date: ___________________
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