Invoice Surgeon in DR Congo Kinshasa –Free Word Template Download with AI
Department of Surgical Excellence
Address: Avenue de la Paix, Gombe
Kinshasa, Democratic Republic of the Congo
Tel: +243 81 000 0000 | Email: [email protected]
Reg. No: RC/KIN/2023/001234
Invoice Number: INV-KIN-SURG-2023-0892
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Currency: Congolese Franc (CDF)
Bill To:
Patient Name: Jean-Pierre Mukendi
Insurance Provider: Assurance Santé Congo (Policy #ASC-998877)
Address: Quartier Lingwala, Kinshasa, DR Congo
Contact: +243 99 123 4567
| # | Description of Surgical Services | Date | Qty | Unit Price (CDF) | Total (CDF) |
|---|---|---|---|---|---|
| 1 |
Pre-Operative Consultation & Assessment Comprehensive evaluation by Lead Surgeon Dr. Antoine Mbala. Includes review of medical history, physical examination, and surgical planning specific to the patient's condition. |
Oct 10, 2023 | 1 | 150,000 | 150,000 |
| 2 |
Diagnostic Imaging & Lab Work MRI Scan and blood panel analysis required for surgical clearance. Conducted at the Centre Médical de l'Équateur laboratory in Kinshasa. |
Oct 11, 2023 | 1 | 250,000 | 250,000 |
| 3 |
General Anesthesia Administration Services provided by certified anesthesiologist during the surgical procedure. Includes monitoring and post-anesthesia care for the first hour. |
Oct 15, 2023 | 1 | 400,000 | 400,000 |
| 4 |
Open Appendectomy Procedure Surgical removal of the appendix performed by Dr. Antoine Mbala. Includes use of operating theater, surgical instruments, and sterile supplies. |
Oct 15, 2023 | 1 | 1,200,000 | 1,200,000 |
| 5 |
Post-Operative Hospital Stay (3 Days) Inpatient care in a private ward at Centre Médical de l'Équateur. Includes nursing care, vital sign monitoring, and basic meals. |
Oct 15-18, 2023 | 3 | 180,000 | 540,000 |
| 6 |
Pharmaceuticals & Medications Antibiotics, pain management, and wound care supplies prescribed for the recovery period. |
Oct 18, 2023 | 1 | 120,000 | 120,000 |
| 7 |
Post-Operative Follow-Up Consultation Wound check and recovery assessment by the Surgeon. Includes suture removal if necessary. |
Oct 22, 2023 | 1 | 100,000 | 100,000 |
| Subtotal: | 2,760,000 CDF |
| Tax (TVA 16%): | 441,600 CDF |
| Total Amount Due: | 3,201,600 CDF |
Terms and Conditions:
1. Payment is due within 30 days of the invoice date. Late payments may incur a penalty fee of 2% per month.
2. This invoice covers all surgical services rendered by the Surgeon at the Centre Médical de l'Équateur in Kinshasa, DR Congo.
3. Insurance claims should be submitted directly to the provider with a copy of this invoice.
4. For any discrepancies or questions regarding this invoice, please contact our billing department at [email protected].
5. All medical procedures were performed in accordance with the standards of the Congolese Medical Council.
6. This document serves as an official record of the financial transaction for the surgical care provided.
Authorized by:
Dr. Antoine Mbala
Lead Surgeon
Centre Médical de l'Équateur
Received by:
__________________________
Date: ____________________
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