Invoice Surgeon in Malaysia Kuala Lumpur –Free Word Template Download with AI
Address: Level 12, Menara Medika, Jalan Tun Razak, 50400 Kuala Lumpur, Malaysia
Phone: +603-2188-9900
Email: [email protected]
Company Reg: 201801023456 (1345678-X)
Medical License: MMC No. 12345
Invoice Number: INV-KL-2023-8892
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Payment Status: Pending
Bill To:
Mr. Tan Wei Ming
15, Jalan Ampang, Off Jalan Sultan Ismail
50450 Kuala Lumpur, Malaysia
IC Number: 850612-14-5678
Phone: +6012-345-6789
Patient Details:
Name: Mr. Tan Wei Ming
Date of Birth: 12 June 1985
Insurance Provider: Great Eastern Life Assurance
Policy Number: GE-99887766
Group ID: KL-CORP-001
| # | Description of Surgical Services | Date of Service | Quantity | Amount (MYR) |
|---|---|---|---|---|
| 1 |
Consultation & Pre-operative Assessment Comprehensive evaluation by Lead Surgeon including medical history review, physical examination, and surgical planning. |
Oct 10, 2023 | 1 | RM 450.00 |
| 2 |
Laparoscopic Cholecystectomy Surgical removal of the gallbladder performed by Senior Consultant Surgeon. Includes use of laparoscopic equipment and surgical team assistance. |
Oct 15, 2023 | 1 | RM 8,500.00 |
| 3 |
Anesthesia Services General anesthesia administration and monitoring during the surgical procedure by certified anesthesiologist. |
Oct 15, 2023 | 1 | RM 1,200.00 |
| 4 |
Operating Theatre Fees Usage of sterile operating theatre facilities at KL Specialist Surgical Centre for a duration of 2 hours. |
Oct 15, 2023 | 1 | RM 1,500.00 |
| 5 |
Post-operative Care & Monitoring Immediate post-surgical monitoring in recovery room and ward nursing care for 24 hours. |
Oct 15, 2023 | 1 | RM 900.00 |
| 6 |
Pathology Examination Histological examination of removed tissue samples to confirm diagnosis. |
Oct 16, 2023 | 1 | RM 350.00 |
| 7 |
Follow-up Consultation Post-surgery review appointment with the Surgeon to assess healing progress and remove sutures/staples. |
Oct 22, 2023 | 1 | RM 250.00 |
Important Notes & Payment Instructions:
This invoice represents the professional fees charged by the Surgeon and the facility fees for services rendered at our Kuala Lumpur clinic. Please note that all amounts are denominated in Malaysian Ringgit (MYR).
Payment Methods:
Payments can be made via bank transfer to Maybank (Account No: 5678 9012 3456), credit card, or cash at our reception desk in Kuala Lumpur.
Please quote the Invoice Number (INV-KL-2023-8892) when making payment.
Insurance Claims:
If you are claiming directly from your insurance provider, please submit this invoice along with the medical report and discharge summary.
Our billing department in Kuala Lumpur is available to assist with pre-authorization queries.
Terms:
Payment is due within 30 days of the invoice date. Late payments may incur a penalty fee of 1.5% per month.
This document serves as an official receipt for tax purposes in Malaysia.
Authorized By:
Dr. Lim Ah Kow
Lead Surgeon & Director
KL Specialist Surgical Centre
Received By:
__________________________
Date: ____________________
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