Invoice Radiologist in Switzerland Zurich –Free Word Template Download with AI

Bill To

Swiss Medical Insurance AG

Claims Department

Bahnhofstrasse 50

8001 Zurich, Switzerland

Policy Holder: Hans Weber

Policy Number: SM-8842910

Payment Instructions

Please transfer the total amount to the following account:

Bank: UBS Switzerland AG

Account Name: Zurich Advanced Radiology Center

IBAN: CH93 0076 2011 6238 5295 7

BIC: UBSWCHZH80A

Reference: ZRC-2023-10-8842

Item	Description of Radiological Services	Code	Qty	Unit Price (CHF)	Total (CHF)
1	Magnetic Resonance Imaging (MRI) - Brain Comprehensive diagnostic imaging of the brain including contrast enhancement. Performed by senior radiologist to assess neurological symptoms. Includes detailed interpretation and written report delivered to referring physician within 24 hours.	20.0090	1	1,250.00	1,250.00
2	Computed Tomography (CT) - Chest High-resolution CT scan of the thorax. Utilizing low-dose protocol for lung screening. Analysis of pulmonary structures and mediastinum. Includes digital archiving of DICOM images accessible via Zurich Health Network.	20.0040	1	850.00	850.00
3	Ultrasound - Abdomen Complete abdominal ultrasound examination. Evaluation of liver, gallbladder, pancreas, spleen, and kidneys. Performed using state-of-the-art 4D ultrasound technology available at our Zurich clinic.	20.0010	1	420.00	420.00
4	Radiologist Consultation & Report Writing Professional fee for the attending radiologist. Includes review of all imaging data, correlation with clinical history, and formulation of a comprehensive diagnostic report. This service ensures high-quality medical interpretation in accordance with Swiss medical standards.	32.0010	3	150.00	450.00
5	Contrast Media Administration Intravenous administration of iodinated contrast agent for CT and Gadolinium-based contrast for MRI. Includes pre-procedure screening for allergies and renal function assessment.	20.0990	2	120.00	240.00
6	Image Archiving and Transmission Secure storage of medical images for the statutory retention period. Transmission of digital files to the referring hospital in Zurich via encrypted HL7/FHIR interface.	20.0995	1	50.00	50.00

Subtotal CHF 3,260.00 VAT (8.1% - Medical Services Rate) CHF 264.06 TOTAL DUE CHF 3,524.06

Terms and Conditions & Important Information

This invoice represents the professional fees for radiological services rendered by a certified radiologist at Zurich Advanced Radiology Center. All services were performed in compliance with the Swiss Medical Association (FMH) guidelines and local regulations in Zurich, Switzerland.

Payment Terms: Payment is due within 30 days of the invoice date. Late payments may incur interest at the statutory rate. Please include the invoice number as the payment reference to ensure proper allocation of funds.

Insurance Claims: This document is formatted to meet the requirements of major Swiss health insurance providers. If you are submitting this for reimbursement, please ensure that the patient's policy number and personal details are clearly visible. Our billing department is available to assist with any queries regarding the codes used (TARMED codes).

Data Privacy: In accordance with the Swiss Federal Act on Data Protection (FADP), all patient data and medical images associated with this invoice are handled with strict confidentiality. Access is restricted to authorized medical personnel only.

Disputes: Should there be any discrepancies regarding the services listed, please contact our billing office within 14 days of receiving this invoice. We are committed to resolving any issues promptly to maintain the high standard of care expected in Zurich's medical community.

Thank you for your trust in our radiology services. We are dedicated to providing accurate diagnoses and supporting the healthcare journey of our patients in Switzerland.

Authorized Signature

Dr. med. Elena Müller
Lead Radiologist
Zurich Advanced Radiology Center ⬇️ Download as DOCX Edit online as DOCX

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