Invoice Radiologist in Venezuela Caracas –Free Word Template Download with AI
Specialized Radiology Services
Av. Francisco de Miranda, Edif. Torre Diamante, Piso 12
Chacao, Caracas, Venezuela
Phone: +58 (212) 555-0199
Email: [email protected]
RIF: J-12345678-9
Invoice #: INV-2023-10-045
Date: October 24, 2023
Due Date: November 07, 2023
Status: Pending Payment
Bill To:
Dr. Elena Rodriguez (Private Practice)
Consultorio Médico "Salud Integral"
Av. Libertador, Centro Comercial La Castellana, Local 45
Caracas, Venezuela
RIF: V-98765432-1
Reference Patient: Juan Carlos Perez (ID: 12-3456789)
This invoice represents the professional fees for diagnostic radiology services rendered by our board-certified Radiologist team at Caracas Advanced Imaging Center. Located in the heart of Caracas, Venezuela, our facility is dedicated to providing state-of-the-art diagnostic imaging solutions, including MRI, CT scans, X-rays, and Ultrasound. The services detailed below were performed in accordance with the highest standards of medical practice and regulatory compliance within Venezuela.
| Description of Service | Code | Quantity | Unit Price (USD) | Total (USD) |
|---|---|---|---|---|
|
Magnetic Resonance Imaging (MRI) - Brain with Contrast Performed by Lead Radiologist. Includes interpretation report. |
MRI-001 | 1 | $250.00 | $250.00 |
|
Computed Tomography (CT) - Chest without Contrast High-resolution scan for pulmonary evaluation. |
CT-005 | 1 | $180.00 | $180.00 |
|
Professional Radiologist Interpretation Fee Detailed analysis and written diagnostic report for both procedures. |
RAD-PROF | 2 | $75.00 | $150.00 |
|
Contrast Media Administration Iodinated contrast agent for MRI procedure. |
MED-CON | 1 | $40.00 | $40.00 |
|
Digital Image Storage & Transmission PACS system access and secure transfer to referring physician. |
TECH-DIG | 1 | $20.00 | $20.00 |
| Subtotal: | $640.00 |
| IVA (16% VAT - Venezuela): | $102.40 |
| Total Amount Due: | $742.40 |
Payment Terms and Conditions:
Currency: Due to economic fluctuations in Venezuela, this invoice is issued in United States Dollars (USD). Payment can be made in USD cash or via bank transfer to our account in Caracas. If paid in Venezuelan Bolívares (VES), the exchange rate will be determined by the official BCV rate on the date of payment.
Due Date: Payment is due within 14 days of the invoice date. Late payments may incur a penalty fee of 2% per month.
Bank Details:
Bank: Banco Mercantil
Account Name: Caracas Advanced Imaging Center C.A.
Account Number: 0105-1234-5678-9012-3456
SWIFT Code: MERCVENC
Medical Disclaimer: The services provided by our Radiologist are for diagnostic purposes only. This invoice does not constitute a medical diagnosis. Please refer to the official radiology report for clinical findings.
Contact: For any questions regarding this invoice or the radiology services provided in Caracas, please contact our billing department at [email protected] or call +58 (212) 555-0199.
Authorized Signature
Dr. Miguel Angel Torres
Chief Radiologist
Received By
__________________________
Date: ____________________
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