Invoice Surgeon in India Mumbai –Free Word Template Download with AI
Department of Advanced Surgical Sciences
Plot No. 42, Bandra Kurla Complex, Bandra East
Mumbai, Maharashtra, India - 400051
Phone: +91 22 6789 1234 | Email: [email protected]
GSTIN: 27AABCM1234D1Z5
Invoice No: MMSI/SURG/2023/8942
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Ref: OPD Case #9921-M
Bill To / Patient DetailsPatient Name: Mr. Rajesh Kumar Sharma
Address: Flat 304, Sea View Apartments, Marine Drive, Mumbai, India - 400020
Contact: +91 98765 43210
Insurance Provider: Star Health & Allied Insurance Co. Ltd.
Policy Number: SHAI-MUM-998877
Attending Surgeon & Procedure DetailsLead Surgeon: Dr. Ananya Deshmukh, MS (Gen), MCh (Surg Gastroenterology)
Registration No: MCRN-12345 (Maharashtra Medical Council)
Procedure Performed: Laparoscopic Cholecystectomy (Gallbladder Removal)
Date of Surgery: October 20, 2023
Operation Theatre: OT-4, Mumbai Metropolitan Surgical Institute
Anesthetist: Dr. Vikram Singh, MD (Anesthesia)
Itemized Charges Breakdown| Description of Service | HSN/SAC Code | Quantity | Rate (INR) | Amount (INR) |
|---|---|---|---|---|
| Consultation Fee - Pre-operative Assessment by Senior Surgeon | 999511 | 1 | 2,500.00 | 2,500.00 |
| Surgical Fee - Laparoscopic Cholecystectomy (Lead Surgeon) | 999511 | 1 | 45,000.00 | 45,000.00 |
| Assistant Surgeon Fee | 999511 | 1 | 10,000.00 | 10,000.00 |
| Anesthesia Charges (General Anesthesia - 2 Hours) | 999511 | 1 | 12,000.00 | 12,000.00 |
| Operation Theatre Usage Fee (4 Hours) | 999511 | 1 | 15,000.00 | 15,000.00 |
| Disposable Surgical Instruments & Laparoscopic Kit | 999511 | 1 | 8,500.00 | 8,500.00 |
| Post-operative Medication & Dressing Materials | 300490 | 1 | 3,200.00 | 3,200.00 |
| Pathology Report (Histopathology of Gallbladder) | 999511 | 1 | 4,800.00 | 4,800.00 |
| ICU Monitoring (Post-op Observation - 6 Hours) | 999511 | 1 | 6,000.00 | 6,000.00 |
| Follow-up Consultation (Included) | 999511 | 1 | 0.00 | 0.00 |
| Subtotal (Taxable Value) | ₹ 1,07,000.00 |
| GST @ 18% (Medical Services) | ₹ 19,260.00 |
| TOTAL AMOUNT DUE | ₹ 1,26,260.00 |
Bank Name: HDFC Bank
Branch: Bandra Kurla Complex, Mumbai
Account Name: Mumbai Metropolitan Surgical Institute
Account Number: 50200012345678
IFSC Code: HDFC0001234
UPI ID: mmsi-mumbai@hdfcbank
Please quote the Invoice Number (MMSI/SURG/2023/8942) in the payment remarks.
Terms and Conditions
- This invoice is issued in accordance with the Goods and Services Tax (GST) Act, 2017, applicable in India.
- Payment is due within 30 days of the invoice date. Late payments may attract interest at 1.5% per month.
- Insurance claims should be processed directly with the respective provider using this invoice and the attached medical reports.
- The Surgeon and the Institute reserve the right to revise charges in case of unforeseen complications requiring extended surgery or ICU stay, subject to prior consent.
- All medical services provided are subject to the standard terms of the Mumbai Metropolitan Surgical Institute.
- For any discrepancies in billing, please contact our accounts department within 7 days of receiving this invoice.
Authorized Signatory
Dr. Ananya DeshmukhLead Surgeon
For Mumbai Metropolitan Surgical Institute
Accounts DepartmentMumbai, India
Thank you for trusting our medical team. We wish you a speedy recovery.
Mumbai Metropolitan Surgical Institute - Excellence in Surgical Care, Mumbai, India.
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