Invoice Surgeon in Ghana Accra –Free Word Template Download with AI
Consultant General & Laparoscopic Surgeon
Accra Specialist Surgical Centre
15 Independence Avenue, Airport Residential Area
Accra, Greater Accra Region, Ghana
Tel: +233 30 277 1234 | Email: [email protected]
Invoice Number: INV-ACC-2023-0892
Date of Issue: October 24, 2023
Due Date: November 07, 2023
Payment Status: Pending
Bill To (Patient/Guarantor)Name: Mrs. Ama Serwaa Osei
Address: Plot 42, East Legon Hills, Accra, Ghana
Phone: +233 24 555 9876
Email: [email protected]
NHIS Number: NHIS-GH-9988776655
Service DetailsDate of Service: October 20, 2023
Procedure: Laparoscopic Cholecystectomy
Diagnosis: Symptomatic Cholelithiasis (ICD-10: K80.2)
Facility: Accra Specialist Surgical Centre, Operating Theatre 2
Surgeon: Dr. Kwame Mensah
Itemized Charges for Surgical Services| Description of Service | Code | Quantity | Unit Price (GHS) | Total Amount (GHS) |
|---|---|---|---|---|
| Pre-operative Surgical Consultation & Assessment in Accra | SURG-CONS-01 | 1 | 450.00 | 450.00 |
| Surgeon's Professional Fee for Laparoscopic Cholecystectomy | CPT-47601 | 1 | 3,500.00 | 3,500.00 |
| Assistant Surgeon Fee (Resident/Associate) | ASST-SURG-02 | 1 | 800.00 | 800.00 |
| Post-operative Ward Visit & Wound Check (Day 1) | POST-OP-01 | 1 | 250.00 | 250.00 |
| Post-operative Follow-up Consultation (Day 7) | FOLLOW-UP-01 | 1 | 300.00 | 300.00 |
| Surgical Disposables & Implants (Trocars, Clips, Staplers) | SURG-SUPP-05 | 1 | 1,200.00 | 1,200.00 |
| Pathology Examination of Gallbladder Specimen | PATH-HIST-01 | 1 | 650.00 | 650.00 |
| Administrative Fee for Medical Records & Invoice Processing | ADMIN-FEE-01 | 1 | 150.00 | 150.00 |
This invoice represents the professional fees and associated costs for surgical services rendered by Dr. Kwame Mensah and the Accra Specialist Surgical Centre team. As a leading surgical practice in Ghana Accra, we adhere to the highest standards of medical billing transparency.
Payment Methods: Payment can be made via Mobile Money (MTN MoMo, Vodafone Cash), Bank Transfer, or Credit/Debit Card. For bank transfers, please use the following details:
Bank: Ecobank Ghana Ltd.
Branch: Airport City Branch, Accra
Account Name: Accra Specialist Surgical Centre Ltd.
Account Number: 1001234567890
Reference: INV-ACC-2023-0892
NHIS Note: A portion of this invoice has been adjusted to reflect the National Health Insurance Scheme (NHIS) capitation for surgical procedures in Ghana. Please present your valid NHIS card at the billing desk for verification. Any balance remaining after NHIS coverage is the responsibility of the patient or guarantor.
Due Date: The full outstanding amount is due within 14 days of the invoice date. Late payments may incur a penalty interest of 2% per month.
Queries: For any questions regarding this invoice, please contact our billing department at +233 30 277 1234 or email [email protected]. We are committed to ensuring clarity and accuracy in all financial matters related to your surgical care in Accra.
Authorized By:
Dr. Kwame Mensah
Lead Surgeon
Received By (Patient/Guarantor):
___________________________
Date: _____________________
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