Invoice Surgeon in Iran Tehran –Free Word Template Download with AI
Specialized Surgical Services
Tehran, Iran
From:
Dr. Ali Rezaei
Board-Certified Surgeon
Specialization: General and Laparoscopic Surgery
Medical License No: IR-TN-2023-45678
Rezaei Surgical Clinic
Valiasr Street, No. 123
Tehran, Iran
Phone: +98 21 1234 5678
Email: [email protected]
To:
Patient Name: [Patient Full Name]
National ID: [Patient National ID]
Address: [Patient Address]
City: Tehran, Iran
Phone: [Patient Phone Number]
Email: [Patient Email]
Invoice Information:
Invoice Number: INV-2023-10-001
Date of Issue: October 15, 2023
Date of Service: October 10, 2023
Due Date: October 30, 2023
Payment Information:
Payment Method: Bank Transfer / Cash
Bank Name: Bank Melli Iran
Account Number: 1234-5678-9012-3456
IBAN: IR12345678901234567890123456
Currency: Iranian Rial (IRR)
| Item No. | Description of Service | Quantity | Unit Price (IRR) | Total (IRR) |
|---|---|---|---|---|
| 1 | Pre-operative Consultation and Assessment | 1 | 5,000,000 | 5,000,000 |
| 2 | Surgical Procedure: Laparoscopic Cholecystectomy | 1 | 150,000,000 | 150,000,000 |
| 3 | Anesthesia Services | 1 | 30,000,000 | 30,000,000 |
| 4 | Operating Room Facility Fee | 1 | 40,000,000 | 40,000,000 |
| 5 | Post-operative Care and Monitoring (24 hours) | 1 | 20,000,000 | 20,000,000 |
| 6 | Medical Supplies and Consumables | 1 | 15,000,000 | 15,000,000 |
| 7 | Follow-up Consultation | 1 | 3,000,000 | 3,000,000 |
Subtotal: 263,000,000 IRR
Tax (9% VAT): 23,670,000 IRR
Total Amount Due: 286,670,000 IRR
Notes and Terms:
1. This invoice is issued for surgical services provided by Dr. Ali Rezaei, a licensed surgeon practicing in Tehran, Iran.
2. Payment is due within 15 days from the date of issue. Late payments may incur a penalty of 2% per month.
3. All prices are in Iranian Rial (IRR) and are subject to change based on current medical rates in Tehran.
4. Insurance claims should be submitted directly to the respective insurance provider. This clinic accepts major Iranian health insurance plans.
5. For any questions regarding this invoice, please contact our office at +98 21 1234 5678 or email [email protected].
6. This document serves as an official record of the surgical services rendered and is valid for accounting and insurance purposes in Iran.
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