Invoice Surgeon in China Shanghai –Free Word Template Download with AI
188 Century Avenue, Pudong New Area
Shanghai, China 200120
Tel: +86 21 5888 9999
Email: [email protected]
Unified Social Credit Code: 91310115MA1K3XXXXX
Invoice Number: INV-SH-2023-10-0045
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Payment Terms: Net 30 Days
Bill To
Mr. David Chen
International Patient Services
450 Huaihai Middle Road, Huangpu District
Shanghai, China 200020
ID/Passport No: E12345678
Service Details
Attending Surgeon: Dr. Li Wei, MD, PhD
Specialty: Orthopedic & Joint Replacement Surgery
Procedure Date: October 20, 2023
Location: Operating Room 3, Shanghai Elite Surgical Center
Diagnosis Code (ICD-10): M17.11 (Unilateral primary osteoarthritis, right knee)
| # | Description of Services | Quantity | Unit Price (CNY) | Total (CNY) |
|---|---|---|---|---|
| 1 |
Surgeon Professional Fee - Primary Comprehensive surgical fee for Total Knee Arthroplasty (Right). Includes pre-operative planning, intra-operative execution, and immediate post-operative assessment by the lead surgeon. |
1 | 25,000.00 | 25,000.00 |
| 2 |
Surgeon Professional Fee - Assistant Fee for the assisting surgeon during the procedure to ensure optimal patient safety and procedural efficiency within the Shanghai Elite Surgical Center standards. |
1 | 8,000.00 | 8,000.00 |
| 3 |
Pre-Operative Surgical Consultation Detailed evaluation, imaging review (MRI/X-Ray), and surgical risk assessment conducted by the surgeon prior to the operation date. |
2 | 1,500.00 | 3,000.00 |
| 4 |
Implant Materials (Knee Prosthesis) High-grade titanium and polyethylene components for the knee replacement, sourced and approved for use in China Shanghai medical facilities. |
1 | 45,000.00 | 45,000.00 |
| 5 |
Operating Room Facility Fee Usage of sterile surgical suite, anesthesia equipment, and nursing staff support for a duration of 3 hours. |
3 | 4,000.00 | 12,000.00 |
| 6 |
Post-Operative Surgeon Follow-up Includes three scheduled follow-up visits to monitor wound healing, range of motion, and overall recovery progress. |
3 | 800.00 | 2,400.00 |
| 7 |
Medical Records & Translation Preparation of detailed surgical reports and translation of medical documents into English for international patient records. |
1 | 1,200.00 | 1,200.00 |
Payment Instructions & Notes
Bank Transfer Details:
Bank Name: Bank of China, Pudong Branch
Account Name: Shanghai Elite Surgical Center Co., Ltd.
Account Number: 4523 8899 0011 2233
SWIFT Code: BKCHCNBJ300
Important: Please reference the Invoice Number (INV-SH-2023-10-0045) in your payment description.
This invoice represents the professional fees for the surgeon and associated surgical services rendered in Shanghai, China. All prices are listed in Chinese Yuan (CNY). Payment is expected within 30 days of the invoice date. Late payments may incur a penalty fee of 1.5% per month. For any discrepancies regarding the surgeon's fees or hospital charges, please contact our billing department immediately.
Authorized By:
Finance Department
Shanghai Elite Surgical Center
Surgeon Certification:
I certify that the services listed above were personally performed or supervised by me.
Dr. Li Wei, MD, PhD
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