Invoice Surgeon in Kenya Nairobi –Free Word Template Download with AI
Dr. James Kamau, MBChB, FCPS (Surgery)
Consultant Surgeon & Medical Director
Westlands Medical Centre, 4th Floor
Chiromo Road, Westlands, Kenya Nairobi
P.O. Box 12345 - 00100, Nairobi
Tel: +254 700 123 456 | Email: [email protected]
KRA PIN: P051234567Z | Medical Practitioners Council Reg: 12345
Invoice Number: NSI-2024-0892
Date of Issue: October 24, 2024
Due Date: November 24, 2024
Payment Status: Pending
Reference: Surgery Case #SC-2024-445
Billed To (Patient/Guarantor)
Name: Sarah Wanjiku Mwangi
ID Number: 28456789
Address: Apt 12B, Kilimani Shoppers Centre
City: Kenya Nairobi, 00100
Phone: +254 722 987 654
Email: [email protected]
Insurance / Third Party Payer
Provider: Jubilee Health Insurance
Policy Number: JHI-987654321
Group ID: CORP-NAIROBI-55
Pre-Authorization Ref: AUTH-2024-7788
Claim Status: Submitted for Adjudication
Service Description: This Invoice details the professional fees and associated costs for surgical services rendered by a qualified Surgeon at our facility in Kenya Nairobi. The procedures were performed in accordance with the standards set by the Kenya Medical Practitioners and Dentists Council (KMPDC) and local healthcare regulations. All services listed below were provided during the patient's admission and outpatient consultations.
| # | Description of Service | Date | Qty | Unit Price (KES) | Total (KES) |
|---|---|---|---|---|---|
| 1 | Consultation Fee - Surgeon Initial surgical assessment and diagnosis by Consultant Surgeon. |
Oct 10, 2024 | 1 | 8,500.00 | 8,500.00 |
| 2 | Pre-Operative Workup Comprehensive medical evaluation, lab tests coordination, and surgical planning. |
Oct 12, 2024 | 1 | 12,000.00 | 12,000.00 |
| 3 | Laparoscopic Cholecystectomy Minimally invasive gallbladder removal surgery performed by Consultant Surgeon. |
Oct 15, 2024 | 1 | 185,000.00 | 185,000.00 |
| 4 | Anesthesia Services General anesthesia administration and monitoring during surgery. |
Oct 15, 2024 | 1 | 45,000.00 | 45,000.00 |
| 5 | Operating Theatre Fees Use of surgical suite, equipment, and nursing staff for 3 hours. |
Oct 15, 2024 | 3 | 15,000.00 | 45,000.00 |
| 6 | Post-Operative Care (Surgeon) Immediate post-surgery monitoring and wound management by the Surgeon. |
Oct 16, 2024 | 1 | 15,000.00 | 15,000.00 |
| 7 | Follow-Up Consultation Post-operative review and suture removal by Consultant Surgeon. |
Oct 22, 2024 | 1 | 5,000.00 | 5,000.00 |
| 8 | Medical Records & Documentation Preparation of surgical reports and discharge summaries. |
Oct 23, 2024 | 1 | 2,500.00 | 2,500.00 |
| Subtotal: | 318,000.00 KES |
| VAT (16%): | 50,880.00 KES |
| Insurance Adjustment: | -150,000.00 KES |
| Grand Total Due: | 218,880.00 KES |
Payment Instructions
Please make payment within 30 days of the invoice date. Late payments may incur a penalty of 2% per month.
Bank Transfer Details:
Bank: Equity Bank Kenya Ltd
Branch: Westlands, Kenya Nairobi
Account Name: Nairobi Surgical Specialists Ltd
Account Number: 0123456789
Sort Code: 234567
M-Pesa Paybill: 522522 (Account: NSI-2024-0892)
Please quote the Invoice Number as reference for all payments.
Terms and Conditions
1. This Invoice is issued in accordance with the tax laws of the Republic of Kenya and is valid for payment processing.
2. All surgical procedures were performed by a licensed Surgeon registered with the Kenya Medical Practitioners and Dentists Council (KMPDC).
3. The services rendered were provided at our medical facility located in Kenya Nairobi, adhering to national healthcare standards.
4. Insurance claims have been submitted separately; this invoice reflects the patient's responsibility after insurance adjustments.
5. Any disputes regarding this invoice must be raised within 14 days of receipt.
6. VAT is charged at the prevailing rate of 16% as per Kenya Revenue Authority (KRA) regulations.
7. This document serves as an official receipt upon confirmation of payment.
Authorized By:
Dr. James Kamau
Consultant Surgeon
Nairobi Surgical Specialists
Date: October 24, 2024
Received By:
_________________________
Name:
Date:
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