Invoice Radiologist in Thailand Bangkok –Free Word Template Download with AI
123 Sukhumvit Road, Khlong Toei Nuea
Watthana District, Bangkok 10110, Thailand
Tax ID: 0-123-45678-9-01-2
Phone: +66 2 123 4567 | Email: [email protected]
Professional Radiology Services
Bill To:
Siriraj Medical Insurance Group
2 Prannok Road, Bangrak
Bangkok 10500, Thailand
Attn: Accounts Payable Department
| # | Description of Radiological Services | Date | Unit Price (THB) | Total (THB) |
|---|---|---|---|---|
| 1 |
Consultation by Senior Radiologist Comprehensive diagnostic review and clinical correlation for complex abdominal imaging cases. Performed by Dr. Somchai J., Board Certified Radiologist in Bangkok. |
Oct 02 | 4,500.00 | 4,500.00 |
| 2 |
MRI Lumbar Spine with Contrast High-resolution magnetic resonance imaging of the lumbar region. Includes intravenous contrast administration, image acquisition, and detailed interpretation report by a specialist radiologist. |
Oct 05 | 12,000.00 | 12,000.00 |
| 3 |
CT Angiography (Head & Neck) Computed Tomography Angiography to assess vascular structures. Includes 3D reconstruction and urgent reporting by the radiology team at our Bangkok facility. |
Oct 10 | 15,500.00 | 15,500.00 |
| 4 |
Mammography Screening & Diagnostic Ultrasound Dual-view digital mammography followed by targeted breast ultrasound. Interpretation by a breast imaging specialist radiologist adhering to BI-RADS standards. |
Oct 12 | 6,800.00 | 6,800.00 |
| 5 |
Interventional Radiology Procedure Image-guided biopsy of hepatic lesion. Includes local anesthesia, ultrasound guidance, tissue sampling, and post-procedure monitoring by the interventional radiologist. |
Oct 15 | 28,000.00 | 28,000.00 |
| 6 |
Pediatric Chest X-Ray (Fluoroscopy) Low-dose fluoroscopic examination for pediatric patient. Specialized technique applied by radiologist to minimize radiation exposure while ensuring diagnostic quality. |
Oct 18 | 3,200.00 | 3,200.00 |
| 7 |
Second Opinion Report - Neuro Radiology Detailed review of external MRI brain scans. Written comprehensive report provided by a senior neuroradiologist based in Thailand Bangkok. |
Oct 20 | 5,000.00 | 5,000.00 |
Terms, Conditions, and Payment Information
Payment Method: Please remit payment via bank transfer to the following account:
Bank: Bangkok Bank
Account Name: Bangkok Advanced Radiology Center Co., Ltd.
Account Number: 123-4-56789-0
SWIFT Code: BKKBTHBK
Due Date: Payment is due within 30 days from the invoice date. Late payments may incur a penalty fee of 1.5% per month.
Service Guarantee: All radiological interpretations are performed by licensed radiologists registered with the Medical Council of Thailand. Our facility in Bangkok adheres to international safety and quality standards.
Disputes: Any discrepancies regarding this invoice must be reported within 14 days of receipt. Please contact our billing department with the invoice number and details of the issue.
Confidentiality: Patient data and medical records referenced in these services are handled in strict accordance with Thailand's Personal Data Protection Act (PDPA).
Authorized Signature:
Dr. Ananya P.
Chief Radiologist & Director
Bangkok Advanced Radiology Center
Received By (Client):
__________________________
Name & Title
Date
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