Invoice Surgeon in Afghanistan Kabul –Free Word Template Download with AI
Advanced Surgical Care in the Heart of Afghanistan
Address: Karte Parwan, Near Sherpur Gate, Kabul, Afghanistan
Phone: +93 (0) 20 123 4567 | Email: [email protected]
Tax Registration No: AF-KBL-987654321
Invoice No: INV-KBL-2024-0892
Date: October 24, 2024
Due Date: November 24, 2024
| Bill To: |
Mr. Ahmad Rahimi Patient ID: PAT-KBL-44592 Address: Wazir Akbar Khan District, Kabul, Afghanistan Phone: +93 (0) 70 987 6543 |
| Surgeon: | Dr. Fatima Nazari, MD, FACS (Board Certified General & Trauma Surgeon) |
| Procedure Date: | October 20, 2024 |
| Facility: | Kabul Specialized Surgical Center, Operating Room 3 |
| Insurance: | Private Health Insurance (Policy No: PHI-AF-112233) |
Itemized Services and Charges
The following invoice details the professional fees and associated costs for surgical services rendered by a qualified surgeon at our facility in Kabul, Afghanistan. All procedures were conducted in accordance with international medical standards and local regulations governing healthcare in Afghanistan.
| Description | Code | Qty | Unit Price (AFN) | Total (AFN) |
|---|---|---|---|---|
| Pre-operative Surgical Consultation and Assessment | 99204 | 1 | 3,500 | 3,500 |
| Diagnostic Imaging Review (Abdominal CT Scan Interpretation) | 74177 | 1 | 2,800 | 2,800 |
| Laparoscopic Cholecystectomy (Gallbladder Removal) - Surgeon Fee | 47562 | 1 | 45,000 | 45,000 |
| General Anesthesia Administration (Surgeon Coordination) | 00840 | 1 | 8,500 | 8,500 |
| Operating Room Facility Fee (2 Hours) | OR-KBL-02 | 2 | 6,000 | 12,000 |
| Surgical Supplies and Implants (Laparoscopic Instruments) | SUP-47562 | 1 | 15,000 | 15,000 |
| Post-operative Surgeon Follow-up Visit (Day 3) | 99212 | 1 | 2,500 | 2,500 |
| Pathology Examination of Removed Tissue | 88305 | 1 | 4,200 | 4,200 |
| Prescription Medications (Antibiotics & Pain Management) | RX-KBL-1024 | 1 | 1,800 | 1,800 |
| Subtotal: | 95,300.00 AFN |
| Insurance Coverage (80%): | -76,240.00 AFN |
| Patient Responsibility (20%): | 19,060.00 AFN |
| Total Amount Due: | 19,060.00 AFN |
Amount in words: Nineteen Thousand Sixty Afghan Afghani only.
Important Notes and Payment Terms:
- This invoice is issued by Kabul Specialized Surgical Center for surgical services provided by a licensed surgeon in Kabul, Afghanistan.
- Payment is due within 30 days of the invoice date. Late payments may incur a 2% monthly interest charge.
- Accepted payment methods: Bank transfer (Bank of Afghanistan), cash (AFN/USD), or mobile money (M-Paisa).
- For bank transfers: Account Name: Kabul Specialized Surgical Center; Bank: Bank Al Habib Afghanistan; Branch: Karte Parwan; Account No: 1234567890.
- Please reference Invoice No. INV-KBL-2024-0892 with all payments.
- This document serves as an official medical invoice for insurance claims, tax purposes, and personal records in accordance with Afghan healthcare regulations.
- Any discrepancies must be reported within 15 days of receipt. Contact our billing department at [email protected] or +93 (0) 20 123 4567.
- All surgical procedures were performed with informed consent and in compliance with the ethical standards of the Afghanistan Medical Association.
Dr. Fatima Nazari, MD, FACS
Lead Surgeon
Kabul Specialized Surgical Center Received by:
_________________________
Patient / Authorized Representative
Date: ___________________
Kabul Specialized Surgical Center | Providing Excellence in Surgical Care Across Afghanistan | Kabul, Afghanistan
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