Invoice Surgeon in France Lyon –Free Word Template Download with AI
Specialist Surgeon | General & Visceral Surgery
15 Rue de la République
69002 Lyon, France
Tel: +33 4 72 00 00 00
Email: [email protected]
SIRET: 123 456 789 00012 | TVA Intracommunautaire: FR 12 123456789
Invoice Number: INV-2023-10-045
Date of Issue: October 24, 2023
Date of Service: October 20, 2023
Due Date: November 24, 2023
Billed To (Patient)
Mr. Jean Dupont
42 Avenue Jean Jaurès
69007 Lyon, France
SS Number: 1 85 04 69 012 345 67
Insurance / Third Party Payer
Caisse Primaire d'Assurance Maladie (CPAM)
Lyon Centre
1 Place de la Comédie
69002 Lyon, France
Conventionné Secteur 1
| Ref | Description of Surgical Services | Code (CCAM) | Qty | Unit Price (€) | Total (€) |
|---|---|---|---|---|---|
| 01 |
Pre-operative Consultation & Assessment Comprehensive evaluation of patient history, physical examination, and surgical planning for abdominal procedure. Includes review of imaging results and risk assessment protocols standard for surgical practice in Lyon. |
KFGA001 | 1 | 25.00 | 25.00 |
| 02 |
Laparoscopic Cholecystectomy Surgical removal of the gallbladder via minimally invasive laparoscopic technique. Procedure performed under general anesthesia. Includes insertion of trocars, dissection of cystic duct and artery, and extraction of organ. Standard surgical intervention performed at the affiliated clinic in Lyon. |
CGCA001 | 1 | 450.00 | 450.00 |
| 03 |
Intra-operative Cholangiography Radiographic imaging of the bile ducts performed during the surgical procedure to ensure patency and rule out common bile duct stones. Essential diagnostic step integrated into the surgical workflow. |
CGCA012 | 1 | 120.00 | 120.00 |
| 04 |
Surgical Dressing & Wound Care Application of sterile dressings to laparoscopic incision sites immediately following the procedure. Includes provision of surgical supplies and bandages required for initial post-operative protection. |
KFGA050 | 1 | 35.00 | 35.00 |
| 05 |
Post-operative Consultation (Day 1) Immediate post-surgical check-up to monitor vital signs, assess pain levels, and verify wound integrity. Includes initial discharge instructions and medication prescription tailored to the patient's recovery needs in Lyon. |
KFGA002 | 1 | 25.00 | 25.00 |
| 06 |
Follow-up Consultation (Day 15) Scheduled review to assess healing progress, remove sutures if necessary, and evaluate overall recovery. Discussion of long-term dietary recommendations and activity restrictions following the cholecystectomy. |
KFGA003 | 1 | 25.00 | 25.00 |
Important Notes & Payment Terms
This invoice represents the professional fees charged by Dr. Alexandre Moreau for surgical services rendered in Lyon, France. The fees listed adhere to the standard tariff conventions (Nomenclature des Actes Professionnels) applicable to surgeons in France.
Payment Methods: Payment can be made via bank transfer (IBAN: FR76 1234 5678 9012 3456 7890 123), credit card, or cash at the clinic reception in Lyon. Please reference the Invoice Number (INV-2023-10-045) on all payments.
Insurance: The amounts deducted for "Sécurité Sociale" and "Mutuelle" are estimates based on standard reimbursement rates. The patient is responsible for settling any discrepancies if the actual reimbursement differs from these estimates. A "Tiers Payant" agreement is in place for direct billing where applicable.
Disputes: Any questions regarding this invoice or the surgical procedures performed should be directed to the clinic administration within 30 days of the invoice date. Late payments may incur a statutory interest charge in accordance with French commercial law.
Authorized Signature
Dr. Alexandre MoreauSurgeon ⬇️ Download as DOCX Edit online as DOCX
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