Invoice Radiologist in Malaysia Kuala Lumpur –Free Word Template Download with AI

Bill To:

Patient Name: Tan Wei Ming

IC Number: 850612-10-XXXX

Address: 45, Jalan Bukit Bintang,
55100 Kuala Lumpur, Malaysia

Referring Physician: Dr. Lim Ah Seng

Invoice Details:

Invoice Number: INV-KL-2023-0892

Service Date: 20 October 2023

Attending Radiologist: Dr. Sarah Tan, MBBS, MRCP(UK), FRCR

Insurance Provider: Great Eastern Life Assurance

Policy Number: GE-99887766

#	Description of Radiological Services	Quantity	Unit Price (MYR)	Total (MYR)
1	MRI Lumbar Spine with Contrast Comprehensive magnetic resonance imaging of the lower back to assess disc herniation and nerve root compression. Includes intravenous contrast administration.	1	1,250.00	1,250.00
2	Specialist Radiologist Interpretation & Reporting Detailed analysis of MRI images by a certified Consultant Radiologist in Kuala Lumpur. Includes written diagnostic report sent to referring physician.	1	450.00	450.00
3	CT Scan Chest (High Resolution) Computed Tomography scan of the thoracic cavity to evaluate lung parenchyma and mediastinal structures.	1	850.00	850.00
4	Ultrasound Abdomen (Complete) Real-time imaging of abdominal organs including liver, gallbladder, pancreas, spleen, and kidneys.	1	350.00	350.00
5	Consultation Fee (Radiologist) Direct consultation with the Radiologist to discuss imaging findings and potential treatment pathways.	1	200.00	200.00

Subtotal: RM 3,100.00 Service Tax (6%): RM 186.00 Insurance Adjustment: RM 0.00 TOTAL DUE (MYR): RM 3,286.00

Payment Terms and Conditions:

This Invoice is issued by KL Advanced Radiology Centre, a premier diagnostic facility located in the heart of Kuala Lumpur, Malaysia. Payment is due within 30 days of the invoice date. Late payments may incur a penalty interest of 1.5% per month.

Bank Transfer Details:
Bank Name: Maybank Berhad
Account Name: KL Advanced Radiology Centre Sdn Bhd
Account Number: 5678 9012 3456
Branch: KL Sentral Branch

Important Note for Patients:
The services rendered by our Radiologist are critical for accurate diagnosis and subsequent treatment planning. In Malaysia, medical imaging standards are strictly regulated by the Ministry of Health. Please ensure that your insurance provider has been notified of these procedures. If you have any questions regarding this Invoice or the medical reports provided by our Radiologist, please contact our billing department in Kuala Lumpur immediately.

Thank you for choosing KL Advanced Radiology Centre for your diagnostic needs. We are committed to providing world-class radiological care in Malaysia.

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