Invoice Surgeon in Israel Tel Aviv –Free Word Template Download with AI
Professional Surgical Services
Provided by: Dr. David Cohen, MD, FACS
Clinic Address: 123 Herzl Street, Tel Aviv-Yafo, Israel
Phone: +972-3-123-4567 | Email: [email protected]
Billed To:Patient Name: Sarah Goldstein
Address: 45 Rothschild Boulevard, Tel Aviv, Israel
ID Number: 123456789
Insurance Provider: Maccabi Healthcare Services
Policy Number: MAC-987654321 Invoice Details:
Invoice Number: INV-TLV-2023-0456
Date of Issue: October 15, 2023
Date of Service: October 10, 2023
Due Date: November 15, 2023
Currency: Israeli New Shekel (ILS)
This invoice pertains to the surgical procedures and related medical services provided by Dr. David Cohen, a board-certified surgeon practicing in Tel Aviv, Israel. The services were rendered at the Tel Aviv Medical Center, a leading healthcare facility in Israel known for its advanced surgical capabilities and commitment to patient care. The following details outline the specific procedures, consultations, and associated costs for the treatment received.
| Item | Description | Quantity | Unit Price (ILS) | Total (ILS) |
|---|---|---|---|---|
| 1 | Pre-operative Consultation with Surgeon | 1 | 800.00 | 800.00 |
| 2 | Surgical Procedure: Laparoscopic Cholecystectomy | 1 | 15,000.00 | 15,000.00 |
| 3 | Anesthesia Services | 1 | 3,500.00 | 3,500.00 |
| 4 | Operating Room Fees | 1 | 4,000.00 | 4,000.00 |
| 5 | Post-operative Care and Monitoring (24 hours) | 1 | 2,500.00 | 2,500.00 |
| 6 | Follow-up Consultation with Surgeon | 1 | 600.00 | 600.00 |
| 7 | Medical Supplies and Medications | 1 | 1,200.00 | 1,200.00 |
Subtotal: 27,600.00 ILS
VAT (17%): 4,692.00 ILS
Total Amount Due: 32,292.00 ILS
Important Notes:
- This invoice is issued in accordance with the regulations of the Israeli Ministry of Health and the Israel Tax Authority.
- Payment is due within 30 days of the invoice date. Late payments may incur a penalty of 1.5% per month.
- Insurance claims should be submitted directly to Maccabi Healthcare Services with a copy of this invoice.
- All surgical procedures were performed by Dr. David Cohen, a licensed surgeon in Israel, at the Tel Aviv Medical Center.
- For any questions regarding this invoice, please contact our billing department at +972-3-123-4567 or email [email protected].
- This document serves as an official record of the medical services provided and is valid for tax and insurance purposes in Israel.
Authorized Signature:
Dr. David Cohen, MD, FACS
Board-Certified Surgeon
Patient Acknowledgment:
Sarah Goldstein
Date: _______________
This invoice is a formal document reflecting the professional surgical services provided in Tel Aviv, Israel. It is intended for use by the patient, insurance providers, and relevant authorities in Israel. All information contained herein is accurate and verifiable.
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