Invoice Surgeon in Mexico Mexico City –Free Word Template Download with AI
Specialized Surgical Services
Av. Paseo de la Reforma 505, Col. Juárez
Del. Cuauhtémoc, Mexico City, CP 06500
Phone: +52 (55) 1234-5678
Email: [email protected]
RFC: CQM-850101-ABC
Invoice Number: INV-2024-0892
Date Issued: October 15, 2024
Due Date: November 15, 2024
Payment Terms: Net 30 Days
Bill To:
Patient Name: Roberto Hernández García
Insurance Provider: Grupo A Seguros
Policy Number: GA-987654321
Address: Calle Insurgentes Sur 1234, Col. Del Valle
City: Mexico City, CP 03100
Phone: +52 (55) 9876-5432
| Description of Services | Procedure Code | Date of Service | Quantity | Unit Price (MXN) | Total (MXN) |
|---|---|---|---|---|---|
| Pre-operative surgical consultation and assessment by specialist surgeon | 99204 | October 1, 2024 | 1 | 3,500.00 | 3,500.00 |
| Laparoscopic cholecystectomy performed by board-certified surgeon | 47562 | October 5, 2024 | 1 | 45,000.00 | 45,000.00 |
| General anesthesia administration during surgical procedure | 00840 | October 5, 2024 | 1 | 12,000.00 | 12,000.00 |
| Operating room facility fees for surgical suite usage | 99291 | October 5, 2024 | 1 | 18,500.00 | 18,500.00 |
| Post-operative surgical follow-up consultation | 99214 | October 12, 2024 | 1 | 2,800.00 | 2,800.00 |
| Surgical supplies and implants used during procedure | 99070 | October 5, 2024 | 1 | 8,200.00 | 8,200.00 |
| Pathology examination of surgical specimens | 88305 | October 6, 2024 | 1 | 4,500.00 | 4,500.00 |
Important Notes and Payment Instructions:
This invoice represents professional surgical services rendered by our qualified surgeon at Centro Quirúrgico Metropolitano, located in the heart of Mexico City. All procedures were performed in accordance with Mexican medical standards and regulations established by the Secretaría de Salud.
Payment is due within 30 days of the invoice date. Please include the invoice number (INV-2024-0892) as reference when making payment. Late payments may incur a 2% monthly interest charge.
For insurance claims, please submit this invoice along with the detailed medical report and procedure documentation to your insurance provider. Our billing department is available to assist with any questions regarding this invoice or the surgical services provided.
Bank Transfer Details:
Bank: BBVA México
Account Name: Centro Quirúrgico Metropolitano S.A. de C.V.
CLABE: 012180001234567890
SWIFT: BVRXMXMM
Authorized by:
Dr. María Elena Rodríguez
Lead Surgeon
Cédula Profesional: 12345678
Billing Department:
Juan Carlos Mendoza
Financial Manager
Centro Quirúrgico Metropolitano
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