Invoice Surgeon in Russia Moscow –Free Word Template Download with AI
12/3 Leninsky Prospekt, Building 5
Moscow, Russia, 119991
Tel: +7 (495) 123-45-67
Email: [email protected]
INN: 7701234567 | KPP: 770101001
Invoice Number: INV-2024-0892
Date of Issue: October 15, 2024
Due Date: November 15, 2024
Payment Terms: Net 30 Days
Bill To:
Patient Name: Alexander Petrov
Address: 45 Tverskaya Street, Apt 12, Moscow, Russia, 125009
Phone: +7 (916) 555-12-34
Email: [email protected]
Insurance Provider: AlfaStrakhovanie Medical
Policy Number: AS-MED-789456123
Service Provider:
Lead Surgeon: Dr. Elena Sokolova, MD, PhD
Specialization: Cardiothoracic Surgery
License Number: LO-77-01-001234
Assisting Surgeon: Dr. Mikhail Ivanov, MD
Facility: Moscow International Surgical Center, Operating Room 4
| Description of Services | Quantity | Unit Price (RUB) | Total (RUB) | VAT (20%) |
|---|---|---|---|---|
| Pre-operative consultation and diagnostic evaluation by Lead Surgeon | 1 | 15,000.00 | 15,000.00 | 3,000.00 |
| Advanced imaging studies (MRI, CT scan) for surgical planning | 1 | 25,000.00 | 25,000.00 | 5,000.00 |
| Cardiothoracic surgical procedure (CABG - Coronary Artery Bypass Graft) | 1 | 450,000.00 | 450,000.00 | 90,000.00 |
| Anesthesia services (general anesthesia with monitoring) | 1 | 40,000.00 | 40,000.00 | 8,000.00 |
| Operating room facility fees (6 hours) | 6 | 12,000.00 | 72,000.00 | 14,400.00 |
| Surgical implants and graft materials | 1 | 85,000.00 | 85,000.00 | 17,000.00 |
| Post-operative intensive care unit (ICU) stay (48 hours) | 2 | 30,000.00 | 60,000.00 | 12,000.00 |
| Post-operative ward stay (5 days) | 5 | 10,000.00 | 50,000.00 | 10,000.00 |
| Post-operative follow-up consultations (3 sessions) | 3 | 8,000.00 | 24,000.00 | 4,800.00 |
| Pharmaceuticals and medical supplies during hospitalization | 1 | 35,000.00 | 35,000.00 | 7,000.00 |
| Subtotal: | 896,000.00 RUB |
| VAT (20%): | 179,200.00 RUB |
| Insurance Coverage: | -400,000.00 RUB |
| Grand Total Due: | 675,200.00 RUB |
Important Notes and Payment Instructions:
This invoice is issued in accordance with the Federal Law of the Russian Federation "On the Fundamentals of Protection of the Health of Citizens in the Russian Federation" and relevant healthcare regulations. All surgical services were performed at our accredited facility in Moscow, Russia, by licensed medical professionals.
Payment is due within 30 days from the date of invoice issuance. Late payments may incur a penalty of 0.1% per day on the outstanding amount.
Bank Details for Payment:
Bank Name: Sberbank of Russia
Account Name: Moscow International Surgical Center LLC
Account Number: 40702810938000123456
BIC: 044525225
Correspondent Account: 30101810400000000225
Please include the invoice number (INV-2024-0892) as the payment reference.
For any questions regarding this invoice or the surgical services provided, please contact our billing department at [email protected] or call +7 (495) 123-45-67, extension 205.
This document serves as an official record of medical services rendered and is valid for insurance claims, tax purposes, and personal records. Please retain a copy for your files.
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