Invoice Surgeon in Ethiopia Addis Ababa –Free Word Template Download with AI

Bill To:

Patient Name: Sarah Johnson

Address: Kazanchis Business District, Addis Ababa

Phone: +251 91 123 4567

Insurance Provider: Ethio Insurance (Policy #ETH-998877)

Invoice Details:

Invoice Number: INV-2023-10-045

Procedure Date: October 20, 2023

Diagnosis Code (ICD-10): K35.80 (Acute appendicitis)

Procedure Code (CPT): 44970 (Laparoscopic appendectomy)

Description of Services	Quantity	Unit Price (ETB)	Total (ETB)
Pre-Operative Surgical Consultation Comprehensive evaluation by the Surgeon in Addis Ababa, including physical examination, review of medical history, and surgical planning.	1	3,500.00	3,500.00
Laparoscopic Appendectomy Procedure Minimally invasive surgical removal of the appendix performed by Dr. Abebe Kebede. Includes surgical time, technical skill, and intraoperative decision-making.	1	45,000.00	45,000.00
Operating Room Facility Fee Usage of sterile surgical suite, anesthesia equipment, and nursing staff support at the Addis Ababa Surgical Center.	1	15,000.00	15,000.00
General Anesthesia Services Administration of anesthesia and monitoring of vital signs throughout the surgical procedure.	1	8,500.00	8,500.00
Surgical Supplies and Implants Laparoscopic instruments, trocars, staplers, and sterile drapes used during the operation.	1	6,000.00	6,000.00
Post-Operative Pathology Analysis Histological examination of the removed tissue to confirm diagnosis and rule out malignancy.	1	2,500.00	2,500.00
Post-Operative Follow-Up Visit Wound check and recovery assessment by the Surgeon 7 days after the procedure.	1	2,000.00	2,000.00

Subtotal: 82,500.00 ETB Insurance Coverage (80%): -66,000.00 ETB Patient Responsibility (20%): 16,500.00 ETB VAT (15% on Patient Portion): 2,475.00 ETB Total Due: 18,975.00 ETB

Terms and Conditions:

This Invoice represents the professional fees for surgical services rendered in Addis Ababa, Ethiopia. Payment is due within 30 days of the invoice date. Late payments may incur a penalty fee of 2% per month. Please reference the Invoice Number (INV-2023-10-045) on all payments.

Payment Methods:
- Bank Transfer: Commercial Bank of Ethiopia, Account Name: Addis Ababa Surgical Specialists, Account No: 1000123456789.
- Cash: Accepted at the clinic reception in Bole, Addis Ababa.
- Telebirr / CBE Birr: Available for immediate payment.

Medical Disclaimer:
The Surgeon has provided care in accordance with the medical standards of Ethiopia and international best practices. This document is for billing purposes only and does not constitute a guarantee of specific medical outcomes. For medical inquiries regarding the procedure, please contact the clinic directly.

Authorized By:

Dr. Abebe Kebede

Lead Surgeon

Received By:

__________________________

Date: ____________________

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