Invoice Surgeon in Nigeria Lagos –Free Word Template Download with AI
Principal Surgeon: Dr. Adebayo Ogunlesi, MBBS, FWACS
14, Admiralty Way, Lekki Phase 1
Lagos, Nigeria
Tel: +234 803 555 0199 | Email: [email protected]
TIN: 12345678-0001
Invoice Number: LMSC-2023-8942
Date Issued: October 24, 2023
Due Date: November 07, 2023
Bill To:
Patient Name: Mrs. Funke Adeyemi
Address: 42, Victoria Island Extension, Lagos, Nigeria
Phone: +234 901 234 5678
Insurance Provider: Leadway Assurance (Policy #LW-998877)
| Description of Service | Quantity | Unit Price (NGN) | Total (NGN) |
|---|---|---|---|
|
Surgeon Professional Fee: Comprehensive surgical fee for the performance of Laparoscopic Cholecystectomy. This covers the surgeon's expertise, pre-operative assessment, intra-operative management, and immediate post-operative care within the Lagos Metropolitan Surgical Centre. |
1 | 850,000.00 | 850,000.00 |
|
Assistant Surgeon Fee: Fee for the qualified surgical assistant present during the procedure to ensure optimal patient safety and procedural efficiency. |
1 | 150,000.00 | 150,000.00 |
|
Anesthesia Services: General anesthesia administration, monitoring, and airway management by a certified anesthesiologist throughout the duration of the surgery. |
1 | 350,000.00 | 350,000.00 |
|
Operating Theatre Usage: Allocation of the sterile operating theatre facility, including nursing staff, sterilization services, and standard surgical equipment usage for 4 hours. |
4 | 75,000.00 | 300,000.00 |
|
Disposable Surgical Supplies: Laparoscopic trocars, staplers, sutures, drapes, and other single-use medical consumables required for the procedure. |
1 | 220,000.00 | 220,000.00 |
|
Post-Operative Medication: Prescribed antibiotics, analgesics, and anti-emetics for the first 7 days of recovery following discharge. |
1 | 45,000.00 | 45,000.00 |
|
Pathology Analysis: Histological examination of the removed gallbladder tissue to rule out malignancy or other abnormalities. |
1 | 60,000.00 | 60,000.00 |
Payment Instructions & Terms:
Please remit the outstanding balance of NGN 623,125.00 by the due date indicated above. Payments can be made via bank transfer to the following account:
Bank: Zenith Bank Plc
Account Name: Lagos Metropolitan Surgical Centre Ltd
Account Number: 1012345678
Reference: Invoice #LMSC-2023-8942
Important Notice: This invoice represents the professional and facility fees for surgical services rendered in Lagos, Nigeria. The Surgeon, Dr. Adebayo Ogunlesi, guarantees the highest standard of care in accordance with the Medical and Dental Council of Nigeria (MDCN) regulations. Please retain this document for your personal records and insurance claims. Late payments may incur a penalty fee of 2% per month.
Authorized By:
Dr. Adebayo Ogunlesi
Lead Surgeon
Received By:
__________________________
Date: ____________________
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