Invoice Surgeon in Algeria Algiers –Free Word Template Download with AI
Specialized Surgical Center
123 Boulevard Mohamed V, Hydra
Algiers, 16000, Algeria
Phone: +213 (0) 21 123 456
Email: [email protected]
NIF: 000123456789012 | NIS: 000123456789012
Invoice Number: INV-2023-ALG-0892
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Service Provider (Surgeon)
Dr. Karim Benali
Board Certified General & Laparoscopic Surgeon
Member of the Algerian Medical Association
Operating at: Clinique El Djazair, Algiers
Bill To (Patient/Insurer)
Mrs. Amina Yacoubi
45 Rue Didouche Mourad
Bab Ezzouar, Algiers, Algeria
CNSS Number: 123456789012345
Private Insurance: CMA CGEM Assurances
Details of Surgical Services Rendered
The following invoice details the professional fees and associated costs for the surgical intervention performed in Algiers, Algeria. This document serves as an official record for the patient and the relevant insurance bodies in accordance with Algerian healthcare regulations.
| # | Description of Service | Date | Quantity | Amount (DZD) |
|---|---|---|---|---|
| 1 |
Pre-Operative Consultation & Assessment Comprehensive evaluation of patient history, physical examination, and surgical planning for laparoscopic cholecystectomy. Includes review of blood work and imaging results obtained in Algiers. |
Oct 10, 2023 | 1 | 15,000.00 |
| 2 |
Professional Surgeon Fee (Laparoscopic Cholecystectomy) Fee for the surgical procedure performed by Dr. Benali. This includes the technical skill, expertise, and time required to perform the minimally invasive removal of the gallbladder. |
Oct 15, 2023 | 1 | 120,000.00 |
| 3 |
Operative Time & Anesthesia Coordination Coordination with the anesthesiologist and surgical team during the 90-minute procedure. Includes intra-operative monitoring and management of surgical complications, if any. |
Oct 15, 2023 | 1 | 45,000.00 |
| 4 |
Surgical Consumables & Implants Cost of specialized laparoscopic instruments, trocars, clips, and sterile drapes used during the surgery. These are billed separately from the hospital facility fees. |
Oct 15, 2023 | 1 | 35,000.00 |
| 5 |
Post-Operative Care & Dressing Change Immediate post-surgical assessment, wound care, and prescription of necessary medications for pain management and infection prevention. |
Oct 16, 2023 | 1 | 10,000.00 |
| 6 |
Follow-Up Consultation Review of recovery progress, removal of sutures (if applicable), and clearance for return to normal activities. Conducted at the clinic in Hydra, Algiers. |
Oct 29, 2023 | 1 | 8,000.00 |
Terms and Conditions
1. Currency: All amounts are quoted in Algerian Dinars (DZD).
2. Payment: Payment is due within 30 days of the invoice date. Late payments may incur a penalty fee as per Algerian commercial law.
3. Insurance: This invoice is submitted for reimbursement purposes. Please attach this document to your claim form for CNSS or your private insurance provider.
4. Validity: This invoice is valid for tax purposes in Algeria. A copy of the medical report is available upon request.
5. Contact: For any discrepancies regarding the surgeon's fees or the services rendered in Algiers, please contact the clinic administration immediately.
Authorized Signature (Surgeon)
Dr. Karim Benali
Patient Acknowledgement
Mrs. Amina Yacoubi
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