Invoice Surgeon in Peru Lima –Free Word Template Download with AI

Bill To:

Patient Name: Carlos Eduardo Mendoza Rivera

Address: Jr. Ancash 1234, Miraflores, Lima, Peru

DNI: 76543210

Insurance Provider: Seguros Pacífico S.A.A.

Policy Number: POL-987654321

Description of Surgical Services	Quantity	Unit Price (PEN)	Total (PEN)
Consultation and Pre-operative Assessment Comprehensive evaluation by Dr. Roberto Sánchez, Board-Certified Surgeon, including medical history review, physical examination, and surgical planning.	1	350.00	350.00
Laparoscopic Cholecystectomy Procedure Minimally invasive surgical removal of the gallbladder performed by Dr. Roberto Sánchez at Clínica Quirúrgica del Pacífico, Lima. Includes surgical technique, anesthesia coordination, and operative time.	1	4,500.00	4,500.00
Anesthesiologist Services General anesthesia administration and monitoring during the surgical procedure by Dr. María Fernández, certified anesthesiologist.	1	1,200.00	1,200.00
Surgical Facility and Operating Room Fees Use of state-of-the-art surgical suite at our Lima facility, including sterilization, equipment, and nursing support staff.	1	1,800.00	1,800.00
Post-operative Care and Recovery Immediate post-surgical monitoring, pain management, and initial recovery care in our surgical recovery unit.	1	650.00	650.00
Follow-up Consultation Post-operative evaluation by the surgeon to assess healing progress and address any concerns.	1	250.00	250.00
Diagnostic Imaging and Laboratory Tests Pre-operative blood work, ultrasound, and other necessary diagnostic procedures.	1	450.00	450.00
Medical Supplies and Consumables Surgical instruments, sutures, dressings, and other materials used during the procedure.	1	350.00	350.00

Subtotal: S/ 9,550.00 IGV (18% VAT): S/ 1,719.00 Insurance Coverage: -S/ 7,831.00 Total Due: S/ 3,438.00

Important Notes:

This invoice represents professional surgical services rendered by Dr. Roberto Sánchez, a board-certified surgeon practicing in Lima, Peru. All procedures were performed in accordance with Peruvian medical standards and regulations established by the Ministry of Health (MINSA) and the National Society of Surgeons of Peru.

The total amount includes all surgical fees, facility charges, and applicable taxes as required by Peruvian law. Payment is due within 30 days of the invoice date. Late payments may incur a 2% monthly interest charge.

Please retain this invoice for your records and for insurance reimbursement purposes. If you have any questions regarding this invoice or the surgical services provided, please contact our billing department at the phone number or email address listed above.

Payment Information:

Bank: Banco de Crédito del Perú (BCP)

Account Name: Clínica Quirúrgica del Pacífico S.A.C.

Account Number: 194-567890-1-23

Currency: Peruvian Soles (PEN)

Reference: INV-2024-0892

Authorized Signature

Dr. Roberto Sánchez

Lead Surgeon

Colegio Médico del Perú No. 45678

Received By

_________________________

Date: _________________

This document constitutes a formal invoice for medical-surgical services provided in Lima, Peru. All services were rendered by qualified medical professionals licensed to practice in Peru. The surgeon and medical facility comply with all applicable Peruvian regulations, including those established by SUNAT (Superintendencia Nacional de Aduanas y de Administración Tributaria) for invoicing purposes. This invoice is valid for tax deduction purposes in accordance with Peruvian tax law. Any disputes regarding this invoice shall be subject to the jurisdiction of the courts of Lima, Peru.

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