Invoice Surgeon in Iraq Baghdad –Free Word Template Download with AI
Specialized Surgical Services
Al-Karrada District, Al-Rashid Street
Baghdad, Iraq
Tax ID: IQ-9988776655
Phone: +964 770 123 4567
Email: [email protected]
Invoice #: INV-2023-10-045
Date: October 24, 2023
Due Date: November 24, 2023
Reference: Surgery Case #BGH-8821
Billed To:
Patient Name: Ahmed Hassan Ali
Insurance Provider: Takaful Al-Mustaqbal (Policy #TAM-554433)
Address: Street 45, Mansour District, Baghdad, Iraq
Contact: +964 780 987 6543
Description of Surgical Services Rendered
This invoice details the professional fees, facility charges, and medical supplies associated with the surgical procedure performed at our facility in Baghdad, Iraq. The following services were provided by our board-certified surgeon and medical team.
| Item / Service Description | Quantity | Unit Price (IQD) | Total (IQD) |
|---|---|---|---|
| Consultation & Pre-operative Assessment Initial evaluation by the surgeon, review of medical history, and surgical planning. |
1 | 150,000 | 150,000 |
| Surgeon's Professional Fee Fee for the performance of the surgical procedure (Open Appendectomy) including anesthesia coordination. |
1 | 2,500,000 | 2,500,000 |
| Anesthesiologist Fee Administration of general anesthesia and monitoring during the procedure. |
1 | 800,000 | 800,000 |
| Operating Room Facility Fee Use of surgical suite, equipment, and nursing staff in Baghdad facility. |
1 | 1,200,000 | 1,200,000 |
| Medical Supplies & Implants Sterile instruments, sutures, and disposable materials used during surgery. |
1 | 450,000 | 450,000 |
| Post-operative Care (24 Hours) Monitoring, pain management, and initial recovery care. |
1 | 600,000 | 600,000 |
| Pathology Analysis Laboratory examination of tissue samples. |
1 | 200,000 | 200,000 |
| Subtotal: | 5,900,000 IQD |
| Insurance Coverage (70%): | -4,130,000 IQD |
| Patient Responsibility (30%): | 1,770,000 IQD |
| Total Due: | 1,770,000 IQD |
Terms and Conditions:
1. Payment is due within 30 days of the invoice date. Late payments may incur a 2% monthly interest charge.
2. This invoice is issued in accordance with the medical regulations of the Ministry of Health in Iraq.
3. Please reference the Invoice Number when making payments via bank transfer or cash at our Baghdad office.
4. For insurance claims, please submit this invoice along with the medical report to your provider.
5. Questions regarding this invoice should be directed to our billing department in Baghdad.
Authorized Signature
Dr. Layla Karim, Chief Surgeon
Al-Rafidain Surgical Center
Patient / Guarantor Signature
Acknowledging receipt and agreement to terms.
⬇️ Download as DOCX Edit online as DOCXCreate your own Word template with our GoGPT AI prompt:
GoGPT