Invoice Surgeon in Japan Kyoto –Free Word Template Download with AI
1-2-3 Shijo-Dori, Kamigyo-ku
Kyoto, Japan 602-0881
Tel: +81-75-555-0123
Email: [email protected]
Corporate Number: 701000100123456
Invoice Number: INV-2023-10-0045
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Payment Terms: Net 30 Days
Bill To:Patient Name: Mr. John Doe
Address: 456 International Plaza, Minami-ku
Kyoto, Japan 601-8000
Insurance Provider: Global Health International
Policy Number: GHI-987654321
Member ID: MH-2023-XYZ
Service Details:This invoice covers professional surgical services rendered by Dr. Kenji Tanaka, Board-Certified Surgeon, at the Kyoto Advanced Surgical Center. The procedures were performed in accordance with the highest standards of medical practice in Japan. All costs listed below are exclusive of consumption tax unless otherwise noted.
| Description of Service | Date of Service | Quantity | Unit Price (JPY) | Total (JPY) |
|---|---|---|---|---|
|
Pre-Operative Consultation & Assessment Comprehensive evaluation by the lead surgeon, including review of medical history, physical examination, and surgical planning. |
Oct 10, 2023 | 1 | 30,000 | 30,000 |
|
Diagnostic Imaging & Laboratory Tests MRI, CT Scan, and blood work required for surgical clearance and precise anatomical mapping. |
Oct 11, 2023 | 1 | 45,000 | 45,000 |
|
Laparoscopic Cholecystectomy (Surgeon Fee) Professional fee for the performance of minimally invasive gallbladder removal surgery by Dr. Kenji Tanaka. Includes intraoperative decision-making and technical execution. |
Oct 15, 2023 | 1 | 350,000 | 350,000 |
|
Anesthesia Services General anesthesia administration and monitoring by certified anesthesiologist during the surgical procedure. |
Oct 15, 2023 | 1 | 80,000 | 80,000 |
|
Operating Room Facility Fee Usage of sterile surgical suite, equipment, and nursing staff at Kyoto Advanced Surgical Center. |
Oct 15, 2023 | 1 | 120,000 | 120,000 |
|
Post-Operative Hospital Stay (2 Nights) Inpatient care, nursing, and monitoring in a private recovery room following surgery. |
Oct 15-17, 2023 | 2 | 50,000 | 100,000 |
|
Post-Operative Follow-Up Consultation Wound check, suture removal, and recovery assessment by the operating surgeon. |
Oct 22, 2023 | 1 | 15,000 | 15,000 |
| Subtotal: | ¥740,000 |
| Consumption Tax (10%): | ¥74,000 |
| Insurance Adjustment: | -¥0 |
| Total Amount Due: | ¥814,000 |
- Bank Transfer Details:
Bank Name: Mizuho Bank, Ltd.
Branch: Kyoto Shijo Branch
Account Type: Ordinary Account
Account Number: 1234567
Account Name: Kyoto Advanced Surgical Center Co., Ltd. - Credit Card Payments: Accepted via secure online portal at payments.kyoto-surgical.jp. Please reference Invoice Number INV-2023-10-0045.
- Late Payment: A late fee of 1.5% per month will be applied to balances unpaid after the due date.
- Insurance Claims: This invoice is formatted to comply with Japanese medical billing standards and international insurance requirements. Please submit a copy to your provider for reimbursement processing.
- Medical Records: A detailed surgical report and discharge summary are available upon request and can be sent directly to your insurance company or primary care physician.
- Contact: For any questions regarding this invoice, please contact our billing department at [email protected] or call +81-75-555-0123 during business hours (Mon-Fri, 9:00 AM - 5:00 PM JST).
Authorized Signature:
Dr. Kenji Tanaka
Chief Surgeon
Kyoto Advanced Surgical Center
Patient Acknowledgment:
_________________________
Date: _________________
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