Invoice Surgeon in Japan Tokyo –Free Word Template Download with AI
Minato-ku, Tokyo, Japan 105-0001
Phone: +81-3-5555-0199
Email: [email protected]
Corporate Number: 1234567890123
Invoice Number: INV-TKY-2023-0892
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Payment Terms: Net 30 Days
Bill To (Insurance Provider / Patient)Global Health Insurance Ltd.
Attn: International Claims Department
1-1-1 Marunouchi, Chiyoda-ku
Tokyo, Japan 100-0005
Policy Number: GH-INT-998877
Patient InformationName: John Doe
Date of Birth: 1980-05-15
Address: Shibuya-ku, Tokyo, Japan
Procedure Date: October 20, 2023
Attending Surgeon: Dr. Kenji Tanaka, MD, PhD
Description of Medical Services and Surgical Procedures| Item | Description | Qty | Unit Price (JPY) | Total (JPY) |
|---|---|---|---|---|
| 1 |
Pre-Operative Surgical Consultation Comprehensive evaluation by Dr. Tanaka at the Tokyo Advanced Surgical Center. Includes review of medical history, physical examination, and surgical planning. |
1 | ¥35,000 | ¥35,000 |
| 2 |
Diagnostic Imaging (MRI & CT Scan) Advanced imaging conducted at our Minato-ku facility to ensure precise surgical mapping prior to the procedure. |
1 | ¥85,000 | ¥85,000 |
| 3 |
Surgeon Professional Fee (Primary) Fee for the attending surgeon, Dr. Kenji Tanaka, for the performance of the Laparoscopic Cholecystectomy. This covers surgical skill, time, and expertise provided in Tokyo. |
1 | ¥450,000 | ¥450,000 |
| 4 |
Assistant Surgeon Fee Professional fee for the assisting surgeon during the operation. |
1 | ¥120,000 | ¥120,000 |
| 5 |
Anesthesiologist Fee General anesthesia administration and monitoring throughout the surgical procedure. |
1 | ¥180,000 | ¥180,000 |
| 6 |
Operating Room Facility Fee Usage of the sterile operating theater, nursing staff, and standard surgical equipment at the Tokyo Advanced Surgical Center. |
1 | ¥250,000 | ¥250,000 |
| 7 |
Surgical Supplies and Implants Disposable surgical instruments, laparoscopic tools, and hemostatic agents used during the procedure. |
1 | ¥95,000 | ¥95,000 |
| 8 |
Post-Operative Hospital Stay (2 Nights) Private room accommodation, nursing care, and medication management following surgery. |
2 | ¥60,000 | ¥120,000 |
| 9 |
Post-Operative Surgeon Follow-Up Consultation with Dr. Tanaka to assess recovery and remove sutures/staples. |
1 | ¥25,000 | ¥25,000 |
Please remit payment via bank transfer to the following account within 30 days of the invoice date.
Bank Name: Mizuho Bank, Ltd.
Branch: Tokyo Head Office
Account Type: Ordinary Account
Account Number: 1234567
Account Name: Tokyo Advanced Surgical Center Co., Ltd.
Important Notes Regarding This Invoice
This invoice represents the total cost of surgical services rendered by the attending surgeon and medical staff at the Tokyo Advanced Surgical Center. All prices are listed in Japanese Yen (JPY).
Insurance Claims: If you are submitting this invoice for insurance reimbursement, please ensure that the patient's policy number and identification details are clearly visible. Our billing department in Tokyo is available to provide additional documentation or itemized breakdowns if required by your insurance provider.
Late Payments: In accordance with Japanese commercial law, late payments may incur interest charges at a rate of 1.5% per month on the outstanding balance.
Medical Records: This invoice does not include the cost of copying medical records. Requests for medical records should be submitted separately to our patient services department.
Thank you for choosing Tokyo Advanced Surgical Center for your medical needs. We are committed to providing world-class surgical care in Japan.
Authorized Signature:
Dr. Kenji TanakaChief of Surgery
Tokyo Advanced Surgical Center
(Hanko/Stamp affixed here)
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