Invoice Surgeon in Saudi Arabia Jeddah –Free Word Template Download with AI
Licensed Medical Facility - Ministry of Health, Saudi Arabia
Address: King Abdullah Road, Al-Rawdah District, Jeddah 21442
Saudi Arabia
Phone: +966 12 555 7890
Email: [email protected]
VAT Registration Number: 300123456789003
Invoice Number: INV-2024-0892
Date of Issue: January 15, 2024
Due Date: February 15, 2024
Payment Terms: Net 30 Days
Service Location: Jeddah, Saudi Arabia
BILL TO:Patient Name: Ahmed Mohammed Al-Fahad
National ID / Iqama Number: 1098765432
Address: Street 45, Al-Shati District, Jeddah 21432, Saudi Arabia
Phone: +966 50 123 4567
Email: [email protected]
Insurance Provider: Bupa Arabia (Policy: BUP-SA-789456)
Referring Physician: Dr. Khalid Al-Saud, Internal Medicine
SURGICAL SERVICES PROVIDED:The following invoice details the comprehensive surgical services rendered by our qualified medical team at Al-Noor Specialized Surgical Center in Jeddah, Saudi Arabia. All procedures were performed in accordance with the standards set by the Saudi Commission for Health Specialties (SCFHS) and the Ministry of Health regulations. The attending surgeon, Dr. Omar Hassan Al-Mansour, is a board-certified specialist with over 15 years of experience in general and laparoscopic surgery.
| Description of Service | Procedure Date | Quantity | Unit Price (SAR) | Total (SAR) |
|---|---|---|---|---|
| Pre-operative Consultation and Assessment by Surgeon | January 10, 2024 | 1 | 800.00 | 800.00 |
| Laparoscopic Cholecystectomy (Gallbladder Removal) | January 12, 2024 | 1 | 18,500.00 | 18,500.00 |
| Anesthesia Services (General Anesthesia) | January 12, 2024 | 1 | 3,200.00 | 3,200.00 |
| Operating Room Facility Fees | January 12, 2024 | 1 | 4,500.00 | 4,500.00 |
| Surgical Instruments and Disposables | January 12, 2024 | 1 | 2,800.00 | 2,800.00 |
| Post-operative Hospital Stay (2 Nights) | January 12-14, 2024 | 2 | 1,500.00 | 3,000.00 |
| Post-operative Medications and Pain Management | January 12-14, 2024 | 1 | 950.00 | 950.00 |
| Follow-up Consultation with Surgeon | January 15, 2024 | 1 | 500.00 | 500.00 |
| Pathology Examination of Removed Tissue | January 13, 2024 | 1 | 1,200.00 | 1,200.00 |
| Medical Reports and Documentation | January 15, 2024 | 1 | 300.00 | 300.00 |
All prices are in Saudi Riyals (SAR). Value Added Tax (VAT) is calculated in accordance with the Saudi Arabian General Authority of Zakat and Tax (GZAT) regulations at the standard rate of 15%.
IMPORTANT NOTES AND TERMS:
1. This invoice is issued for surgical services provided at Al-Noor Specialized Surgical Center, located in Jeddah, Saudi Arabia. All medical procedures were conducted by licensed surgeons registered with the Saudi Commission for Health Specialties (SCFHS).
2. Payment is due within 30 days from the date of invoice issuance. Late payments may incur a penalty of 2% per month on the outstanding balance, in accordance with Saudi Arabian commercial regulations.
3. For insurance claims, please submit this invoice along with the detailed medical report, procedure codes, and any additional documentation required by your insurance provider. Our billing department is available to assist with insurance processing.
4. The surgeon and medical team at Al-Noor Specialized Surgical Center adhere to the highest standards of medical practice and patient care as mandated by the Ministry of Health, Saudi Arabia. All equipment and facilities meet international safety and quality standards.
5. If you have any questions regarding this invoice or the services provided, please contact our billing department at +966 12 555 7890 or email [email protected]. We are committed to ensuring transparency and clarity in all financial matters.
6. This document serves as an official record of the surgical services rendered and may be required for tax, insurance, or legal purposes within Saudi Arabia.
Authorized Signature:
Dr. Omar Hassan Al-Mansour
Lead Surgeon
SCFHS License No: 1234567
Billing Department:
Sara Al-Harbi
Senior Billing Officer
Al-Noor Specialized Surgical Center
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