Invoice Surgeon in Egypt Cairo –Free Word Template Download with AI
15th of May Street, Nasr City
Cairo, Egypt 11351
Tel: +20 2 2414 5555
Email: [email protected]
Invoice Number: INV-EG-2023-0892
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Reference: Surgery Case #SC-4491
Bill ToPatient Name: Ahmed Hassan Mohamed
National ID: 29801234567890
Address: 42 Corniche El Nil, Zamalek, Cairo, Egypt
Phone: +20 100 123 4567
Insurance Provider: AXA Mansour Health Insurance
Policy Number: AXA-EG-998877
Group ID: CORP-CAIRO-001
Authorization Code: AUTH-7721
Surgeon InformationLead Surgeon: Dr. Sarah El-Sayed, MD, FACS
Specialization: Orthopedic & Joint Replacement Surgery
Licence Number: EGY-MED-5542
Clinic Location: Nile Valley Surgical Center, Cairo, Egypt
Description of ServicesThis invoice details the professional fees and associated costs for surgical procedures performed in Cairo, Egypt. The services rendered include pre-operative consultation, the surgical intervention itself, anesthesia, and immediate post-operative care within the facility.
| # | Description of Service | Date | Unit Price (EGP) | Total (EGP) |
|---|---|---|---|---|
| 1 | Pre-Operative Consultation & Assessment Comprehensive evaluation by the Surgeon, including medical history review and imaging analysis. |
Oct 10, 2023 | 2,500.00 | 2,500.00 |
| 2 | Total Knee Arthroplasty (Right) Primary surgical procedure performed by Dr. Sarah El-Sayed. Includes surgical time, technical skill, and intra-operative decision making. |
Oct 15, 2023 | 45,000.00 | 45,000.00 |
| 3 | General Anesthesia Services Administration and monitoring by certified anesthesiologist during the procedure. |
Oct 15, 2023 | 8,000.00 | 8,000.00 |
| 4 | Operating Room Facility Fees Usage of sterile surgical suite, nursing staff, and standard equipment at the Cairo facility. |
Oct 15, 2023 | 12,000.00 | 12,000.00 |
| 5 | Implants & Prosthetics Cemented knee prosthesis system (Brand: Zimmer Biomet). Cost of hardware used in surgery. |
Oct 15, 2023 | 35,000.00 | 35,000.00 |
| 6 | Post-Operative Recovery & Monitoring PACU care and immediate post-surgical observation for 6 hours. |
Oct 15, 2023 | 4,500.00 | 4,500.00 |
| 7 | Pathology & Lab Tests Intra-operative tissue sampling and standard blood work. |
Oct 15, 2023 | 3,000.00 | 3,000.00 |
| 8 | Follow-Up Consultation Post-surgical check-up by the Surgeon to assess wound healing and mobility. |
Oct 22, 2023 | 1,500.00 | 1,500.00 |
1. Payment Method: Payment is expected within 30 days of the invoice date. Payments can be made via bank transfer to our account at Banque Misr, Cairo Branch, or via credit card at the clinic reception.
2. Currency: All amounts are quoted in Egyptian Pounds (EGP). Exchange rates apply if payment is made in foreign currency.
3. Insurance Claims: This invoice is formatted to comply with standard medical billing requirements in Egypt. Please submit this document along with the medical report to your insurance provider for reimbursement if not paid directly.
4. Late Fees: A late fee of 2% per month will be applied to outstanding balances after the due date.
5. Disputes: Any discrepancies regarding the Surgeon's fees or services rendered must be reported within 15 days of receiving this invoice.
6. Privacy: Patient data is handled in accordance with Egyptian medical privacy laws and international standards.
Authorized By:
Dr. Sarah El-SayedLead Surgeon
Received By:
Patient / RepresentativeDate: _______________ ⬇️ Download as DOCX Edit online as DOCX
Create your own Word template with our GoGPT AI prompt:
GoGPT