Invoice Surgeon in Nepal Kathmandu –Free Word Template Download with AI
Plot No. 12, Durbar Marg Extension
Kathmandu, Nepal
Phone: +977-1-4422334 | Email: [email protected]
PAN/VAT No: 123456789
Invoice No: INV-2024-0892
Date: October 24, 2024
Due Date: November 07, 2024
Payment Status: Pending
Bill ToPatient Name: Rajesh Sharma
Address: House No. 45, New Baneshwor, Kathmandu, Nepal
Contact: +977-9841234567
Insurance Provider: Himalayan Health Insurance Ltd.
Policy Number: HHI-987654321
Service ProviderSurgeon: Dr. Anjali Thapa, MD, MS (Surgery)
Specialization: Orthopedic & Trauma Surgery
License No: NMC-REG-45678
Hospital Affiliation: Shree Pashupati Surgical Center, Kathmandu
Description of Surgical Services| # | Description of Service | Date | Qty | Unit Price (NPR) | Total (NPR) |
|---|---|---|---|---|---|
| 1 | Pre-operative Consultation & Diagnostic Evaluation by Surgeon | Oct 15, 2024 | 1 | 5,000.00 | 5,000.00 |
| 2 | Advanced Imaging (MRI Knee Joint) - Referral Fee | Oct 16, 2024 | 1 | 12,000.00 | 12,000.00 |
| 3 | Surgical Procedure: Arthroscopic Knee Repair (Surgeon Fee) | Oct 20, 2024 | 1 | 150,000.00 | 150,000.00 |
| 4 | Anesthesia Services (General Anesthesia) | Oct 20, 2024 | 1 | 25,000.00 | 25,000.00 |
| 5 | Operating Room Facility Charges (3 Hours) | Oct 20, 2024 | 3 | 15,000.00 | 45,000.00 |
| 6 | Implants & Surgical Consumables (Meniscus Repair Kit) | Oct 20, 2024 | 1 | 35,000.00 | 35,000.00 |
| 7 | Post-operative Hospital Stay (2 Nights - Private Ward) | Oct 20-22, 2024 | 2 | 10,000.00 | 20,000.00 |
| 8 | Post-operative Medications & Dressing Supplies | Oct 22, 2024 | 1 | 8,000.00 | 8,000.00 |
| 9 | Follow-up Consultation with Surgeon (First Visit) | Oct 28, 2024 | 1 | 3,000.00 | 3,000.00 |
| 10 | Physiotherapy Session Package (5 Sessions) | Oct 29 - Nov 02, 2024 | 5 | 2,000.00 | 10,000.00 |
| Subtotal: | NPR 313,000.00 |
| Insurance Coverage (70%): | - NPR 219,100.00 |
| Discount (Loyalty Patient): | - NPR 5,000.00 |
| Net Amount Payable: | NPR 88,900.00 |
| VAT (13% on Net Amount): | NPR 11,557.00 |
| Total Due: | NPR 100,457.00 |
Please make payment within 14 days of the invoice date. Payments can be made via bank transfer, cash, or mobile banking (eSewa/Khalti).
Bank Name: Nepal Investment Bank Limited
Branch: Durbar Marg, Kathmandu
Account Name: Shree Pashupati Surgical Center
Account Number: 0123456789012
SWIFT Code: NIBLNPKT
1. This invoice is issued in accordance with the medical services provided by the surgeon at Shree Pashupati Surgical Center, Kathmandu, Nepal.
2. All amounts are in Nepalese Rupees (NPR).
3. Insurance claims must be submitted within 30 days of discharge.
4. Late payments may incur a penalty of 2% per month.
5. For any discrepancies, please contact our billing department within 7 days.
6. This document serves as an official receipt upon payment confirmation.
7. The surgeon’s professional fees are non-refundable once the procedure is completed.
8. Patient is responsible for verifying insurance coverage prior to treatment.
Authorized Signature
Dr. Anjali Thapa
Lead Surgeon
Received By
Rajesh Sharma
Patient / Authorized Representative
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