Invoice Speech Therapist in Iran Tehran –Free Word Template Download with AI
Speech Therapist Professional Services
Licensed Clinical Practice – Iran Tehran
Speech Therapist (Provider)
Name: Dr. Maryam Ahmadi, M.S. Speech-Language Pathology
License No.: IR-SLP-2019-00347
Clinic: Tehran Advanced Speech & Language Center
Address: No. 42, Valiasr Street, 17th Floor, Tehran, Iran
Phone: +98 21 8876 5432
Email: [email protected]
Tax ID (Shenase Melli): 1024567890
Client / Patient
Name: Mr. Reza Karimi
Patient ID: PT-2025-00912
Address: No. 8, Enghelab Avenue, District 2, Tehran, Iran
Phone: +98 912 345 6789
Referring Physician: Dr. Hassan Mohammadi, Neurologist
Insurance Provider: Iran Health Insurance Organization (Bimeh Salamat)
Policy No.: BSO-2025-7784321
Description of Speech Therapist Services Rendered
This Invoice documents the professional Speech Therapist services provided by Dr. Maryam Ahmadi at the Tehran Advanced Speech & Language Center, located in the heart of Iran Tehran. The following services were delivered during the billing period of 1 June 2025 through 14 June 2025, in accordance with the treatment plan approved by the referring neurologist and the client's insurance coverage under the Iran Health Insurance Organization.
| Ref # | Date | Service Description | Duration | Rate (IRR) | Amount (IRR) |
|---|---|---|---|---|---|
| 01 | 01 Jun 2025 | Initial Speech Therapist Assessment – Comprehensive articulation and phonological evaluation for a 7-year-old child presenting with persistent speech sound disorders | 60 min | 1,200,000 | 1,200,000 |
| 02 | 03 Jun 2025 | Individual Speech Therapy Session – Targeted articulation drills for /r/, /l/, and /s/ phonemes; parent coaching on home practice strategies | 45 min | 900,000 | 900,000 |
| 03 | 05 Jun 2025 | Speech Therapist Group Session – Small group (4 children) speech production therapy focusing on consonant cluster simplification | 50 min | 600,000 | 600,000 |
| 04 | 07 Jun 2025 | Fluency Therapy Session – Stuttering intervention using fluency shaping and pull-out techniques for a 12-year-old patient | 45 min | 900,000 | 900,000 |
| 05 | 09 Jun 2025 | Speech Therapist Progress Evaluation – Mid-cycle assessment of articulation accuracy; updated treatment plan documentation and parent consultation | 30 min | 700,000 | 700,000 |
| 06 | 11 Jun 2025 | Individual Speech Therapy Session – Language formulation therapy; expanding sentence length and grammatical complexity for a 5-year-old with expressive language delay | 45 min | 900,000 | 900,000 |
| 07 | 13 Jun 2025 | Speech Therapist Home Visit – In-home speech therapy session in District 2, Tehran; environmental modification recommendations and caregiver training | 60 min | 1,500,000 | 1,500,000 |
| 08 | 14 Jun 2025 | Administrative – Preparation of detailed progress report for insurance claim submission to Bimeh Salamat; documentation of Speech Therapist clinical notes | 30 min | 400,000 | 400,000 |
| Subtotal | 7,100,000 IRR |
| Insurance Co-Pay (20%) | -1,420,000 IRR |
| VAT (9% – Iran Standard Rate) | 547,200 IRR |
| Grand Total Due | 6,227,200 IRR |
Accepted Payment Methods (Iran Tehran)
- Bank Transfer – Bank Melli Iran, Account: 010-234-5678-9012 (IBAN: IR01 0102 3456 7890 1200 0000)
- Shetab Card Payment at the Tehran Advanced Speech & Language Center front desk
- Online Payment via the clinic's secure portal: pay.tehspeech.ir
- Cash Payment (receipt will be issued upon request)
Important Notes & Terms
1. This Invoice is issued in accordance with the regulations of the Iranian Ministry of Health and Medical Education governing Speech Therapist professional billing practices in Iran Tehran.
2. All Speech Therapist services listed above have been performed by a licensed and certified Speech Therapist holding a valid practice license issued by the Tehran Provincial Health Department.
3. The insurance co-payment amount reflects the standard 20% patient responsibility under the Bimeh Salamat policy. The remaining 80% has been submitted directly to the insurance provider for reimbursement.
4. Payment is due within fifteen (15) calendar days from the issue date of this Invoice. Late payments are subject to a 2% monthly surcharge as per Iranian commercial law.
5. This Invoice must be retained by the client for a minimum of five (5) years in compliance with Iranian tax and financial record-keeping regulations.
6. For any disputes regarding the services rendered or the amounts billed on this Invoice, the client may contact the Speech Therapist's supervising authority at the Tehran Medical Association within thirty (30) days.
7. All personal data contained in this Invoice is protected under the Iranian Personal Data Protection Law. Unauthorized distribution of this document is strictly prohibited.
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