Invoice Surgeon in Brazil Rio de Janeiro –Free Word Template Download with AI
Specialist Surgeon - CRM-RJ 78945
Av. Atlântica, 1702 - Copacabana
Rio de Janeiro, RJ - 22021-001
Brazil
Phone: +55 (21) 3245-6789
Email: [email protected]
CNPJ: 12.345.678/0001-90
Invoice Number: INV-2023-0456
Date: November 15, 2023
Due Date: December 15, 2023
Payment Terms: Net 30
Billed To:
Patient Name: Maria Silva Santos
CPF: 123.456.789-00
Address: Rua das Flores, 456 - Apt 102
Neighborhood: Leblon
City: Rio de Janeiro, RJ - 22430-000
Country: Brazil
Phone: +55 (21) 98765-4321
Email: [email protected]
Insurance Provider: Amil Saúde
Policy Number: AM-987654321
| Description | Quantity | Unit Price (BRL) | Total (BRL) |
|---|---|---|---|
| Pre-operative Consultation and Evaluation | 1 | R$ 450.00 | R$ 450.00 |
| Surgical Procedure: Laparoscopic Cholecystectomy | 1 | R$ 8,500.00 | R$ 8,500.00 |
| Anesthesia Services (General Anesthesia) | 1 | R$ 2,200.00 | R$ 2,200.00 |
| Hospital Stay - Private Room (2 nights) | 2 | R$ 1,800.00 | R$ 3,600.00 |
| Post-operative Follow-up Consultations (3 sessions) | 3 | R$ 300.00 | R$ 900.00 |
| Laboratory Tests and Imaging Studies | 1 | R$ 750.00 | R$ 750.00 |
| Medical Supplies and Consumables | 1 | R$ 600.00 | R$ 600.00 |
| Administrative and Documentation Fees | 1 | R$ 200.00 | R$ 200.00 |
Subtotal: R$ 17,200.00
Discount (Insurance Coverage): -R$ 12,000.00
Patient Responsibility: R$ 5,200.00
Total Amount Due: R$ 5,200.00
Important Notes:
This invoice represents the professional fees and associated costs for surgical services provided by Dr. Carlos Eduardo Mendes, a licensed surgeon practicing in Rio de Janeiro, Brazil. All procedures were performed in accordance with the standards set by the Brazilian Federal Council of Medicine (CFM) and the Rio de Janeiro Regional Medical Council (CRM-RJ).
The patient, Maria Silva Santos, underwent a laparoscopic cholecystectomy on November 10, 2023, at Hospital Santa Cruz, located in the Tijuca neighborhood of Rio de Janeiro. The procedure was successful, and the patient was discharged on November 12, 2023, following a two-night hospital stay.
Payment is due within 30 days of the invoice date. Late payments may incur a penalty of 2% per month, in accordance with Brazilian consumer protection laws. Payment can be made via bank transfer, credit card, or cash at our clinic located in Copacabana, Rio de Janeiro.
For bank transfer details, please contact our administrative office at +55 (21) 3245-6789 or email [email protected]. If you have any questions regarding this invoice or the services provided, please do not hesitate to reach out to us.
This document serves as an official invoice for tax and accounting purposes in Brazil. Please retain a copy for your records. The CNPJ number provided above is registered with the Brazilian Federal Revenue Service (Receita Federal).
Thank you for trusting our medical services.
Dr. Carlos Eduardo Mendes
Specialist Surgeon - CRM-RJ 78945
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