Invoice Surgeon in India New Delhi –Free Word Template Download with AI
Lead Surgeon: Dr. Rajesh Kumar, MS, MCh (Cardiothoracic)
42, Institutional Area, Sector 62
Noida Extension, New Delhi, India - 110001
Phone: +91-11-4567-8900 | Email: [email protected]
GSTIN: 07AABCD1234E1Z5
Invoice No: DS-2023-8942
Date: October 24, 2023
Due Date: November 07, 2023
Payment Terms: Net 14 Days
Bill To (Insurance / Patient)Max Bupa Health Insurance Ltd.
Policy Holder: Mr. Amit Sharma
Policy Number: MB-9988776655
18, Barakhamba Road
New Delhi, India - 110001
Patient DetailsName: Mr. Amit Sharma
Age/Gender: 54 / Male
Admission Date: October 20, 2023
Discharge Date: October 23, 2023
Diagnosis: Coronary Artery Disease requiring CABG
Surgeon Professional Fees & Surgical ServicesThe following invoice details the professional fees charged by the attending Surgeon for the surgical procedure performed at the Delhi Advanced Surgical Institute in New Delhi, India. These charges cover pre-operative consultation, the surgical intervention, and immediate post-operative care.
| # | Description of Service | Quantity | Unit Price (INR) | Total (INR) |
|---|---|---|---|---|
| 1 |
Pre-Operative Surgical Consultation Comprehensive evaluation by the Lead Surgeon to assess cardiac health and determine surgical necessity. |
1 | 5,000.00 | 5,000.00 |
| 2 |
Coronary Artery Bypass Grafting (CABG) Major open-heart surgery performed by the Surgeon to restore blood flow to the heart muscle. Includes surgical time and technical expertise. |
1 | 2,50,000.00 | 2,50,000.00 |
| 3 |
Assistant Surgeon Fees Professional fees for the assisting surgeon during the complex procedure. |
1 | 40,000.00 | 40,000.00 |
| 4 |
Post-Operative Ward Rounds Daily monitoring and assessment by the Surgeon during the 3-day hospital stay in New Delhi. |
3 | 3,000.00 | 9,000.00 |
| 5 |
Emergency Re-exploration (If Required) Provisional charge for potential immediate post-surgical intervention (Waived as not utilized). |
0 | 75,000.00 | 0.00 |
Please make the payment via Bank Transfer or NEFT/RTGS to the following account details registered in India:
- Bank Name: State Bank of India
- Account Name: Delhi Advanced Surgical Institute
- Account Number: 30598877665544
- IFSC Code: SBIN0001234
- Branch: Connaught Place, New Delhi
- This invoice represents the professional fees of the Surgeon only. Hospital room charges, anesthesia, and pharmacy costs are billed separately.
- Payment is due within 14 days of the invoice date. Late payments may incur a penalty of 2% per month.
- All services were rendered in accordance with the medical standards of New Delhi, India.
- For any discrepancies regarding this invoice, please contact the billing department at [email protected].
- This document serves as a valid tax invoice for GST purposes in India.
Authorized Signatory
Dr. Rajesh Kumar
Lead Surgeon
Received By
__________________________
Date: ____________________
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