Invoice Surgeon in France Marseille –Free Word Template Download with AI
Specialist Surgeon | Orthopedic & Traumatology
15 Avenue du Prado
13008 Marseille, France
Tel: +33 4 91 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
Bill To (Insurance / Patient)
Mutuelle Santé Provence
Attn: Claims Department
42 Rue de la République
13001 Marseille, France
Policy Holder ID: MS-889210
Patient Information
Name: Jean-Pierre Dubois
SSN (Numéro de Sécurité Sociale): 1 85 04 13 008 123 45
Address: 8 Impasse des Mimosas, 13008 Marseille
Procedure Date: October 20, 2023
| # | Description of Surgical Services | CCAM Code | Qty | Unit Price (€) | Total (€) |
|---|---|---|---|---|---|
| 1 |
Pre-operative Consultation & Assessment Comprehensive evaluation of the patient's condition in Marseille clinic. Includes review of MRI scans, physical examination of the knee joint, discussion of surgical risks and benefits, and preparation of the surgical plan. |
QFCA001 | 1 | 120.00 | 120.00 |
| 2 |
Arthroscopic Knee Surgery (Meniscectomy) Surgical intervention performed at the Hôpital de la Timone, Marseille. Procedure involved arthroscopic resection of the medial meniscus. Includes use of surgical instruments, anesthesia coordination, and operative time. |
FGKA002 | 1 | 1,850.00 | 1,850.00 |
| 3 |
Post-operative Care & Dressing Change Immediate post-surgical monitoring and wound care. Includes application of sterile dressings, prescription of analgesics and antibiotics, and initial mobility assessment. |
QFCA005 | 1 | 150.00 | 150.00 |
| 4 |
Follow-up Consultation (Day 15) Scheduled review to assess healing progress, suture removal if necessary, and adjustment of rehabilitation protocol. Conducted at the surgeon's private office in Marseille. |
QFCA003 | 1 | 90.00 | 90.00 |
| 5 |
Medical Certificate & Administrative Fees Issuance of official medical certificate for work absence (Arrêt de travail) and administrative processing of the invoice for French Social Security reimbursement. |
Admin | 1 | 40.00 | 40.00 |
Payment Instructions & Terms
Please remit payment within 30 days of the invoice date. Payments can be made via bank transfer to the following account:
Bank: BNP Paribas Marseille
IBAN: FR76 3000 4000 0000 0000 0000 000
BIC: BNPAFRPP
Reference: INV-2023-10-045
Important Medical & Legal Information
This invoice represents the professional fees charged by Dr. Alexandre Moreau for surgical services rendered in Marseille, France. The fees are calculated in accordance with the standard tariff guidelines for surgeons in the Provence-Alpes-Côte d'Azur region.
The CCAM codes listed correspond to the official French classification of medical acts. This document serves as the primary proof of service for reimbursement claims submitted to the French National Health Insurance (Assurance Maladie) and complementary private insurance (Mutuelle).
Please note that hospitalization fees, anesthesia fees, and radiology costs are billed separately by the Hôpital de la Timone and are not included in this surgeon's invoice. The patient is responsible for any remaining balance not covered by insurance after the application of the "Ticket Modérateur."
For any questions regarding this invoice or the surgical procedure, please contact the administrative office of Dr. Moreau in Marseille during business hours (Monday to Friday, 9:00 AM - 5:00 PM).
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