Invoice Surgeon in Saudi Arabia Riyadh –Free Word Template Download with AI

Bill To (Patient / Insurance)

Name: Ahmed Al-Fahad

National ID / Iqama: 1098765432

Address: Al Malqa District, Riyadh, Saudi Arabia

Phone: +966 50 123 4567

Insurance Provider: Bupa Arabia

Policy Number: BUP-SA-998877

Service Provider (Surgeon)

Dr. Sarah Al-Mutairi, MD, FACS

Specialty: Orthopedic & Joint Replacement Surgeon

License Number: MOC-SA-778899

Hospital Affiliation: Riyadh Advanced Surgical Center

Location: Riyadh, Saudi Arabia

Detailed Description of Surgical Services Rendered

This invoice represents the professional fees and associated costs for the surgical procedure performed by the attending Surgeon at our facility in Riyadh, Saudi Arabia. The procedure was conducted in accordance with the Ministry of Health regulations and international medical standards.

#	Description of Service	Date	Quantity	Amount (SAR)
1	Primary Surgical Procedure: Total Knee Arthroplasty (Right Knee). Performed by Dr. Sarah Al-Mutairi. Includes pre-operative assessment, anesthesia coordination, and surgical execution.	Oct 20, 2023	1	25,000.00
2	Surgeon Professional Fee: Consultation, operative time, and immediate post-operative care provided by the Surgeon.	Oct 20, 2023	1	8,500.00
3	Anesthesiologist Fee: General anesthesia administration and monitoring during the surgery.	Oct 20, 2023	1	4,200.00
4	Operating Room Charges: Usage of sterile surgical suite, nursing staff, and medical equipment at Riyadh Advanced Surgical Center.	Oct 20, 2023	1	6,000.00
5	Implants and Prosthetics: Premium ceramic-on-polyethylene knee implant system (Medtronic).	Oct 20, 2023	1	12,000.00
6	Post-Operative Hospital Stay: 3 nights in a private recovery room including nursing care and medication.	Oct 20-23, 2023	3	4,500.00
7	Follow-up Consultation: Post-surgery evaluation by the Surgeon to ensure proper healing and mobility.	Oct 27, 2023	1	500.00

Subtotal: 60,700.00 SAR VAT (15%): 9,105.00 SAR Total Due: 69,805.00 SAR

Payment Instructions & Terms

Please remit payment within 30 days of the invoice date. Payments can be made via bank transfer to Al Rajhi Bank, Account Name: Riyadh Advanced Surgical Center, IBAN: SA03 8000 0000 6080 1016 7519.

Insurance Claims: If this invoice is to be processed by your insurance provider, please ensure that the pre-authorization number is included in your submission. Our billing department in Riyadh is available to assist with any claims discrepancies.

Legal Notice: This document serves as a formal request for payment for medical services rendered by a licensed Surgeon in Saudi Arabia. All prices are inclusive of the standard 15% Value Added Tax (VAT) as mandated by the Zakat, Tax and Customs Authority (ZATCA).

Thank you for trusting our medical team with your health. We are committed to providing world-class surgical care in Riyadh.

Authorized Signature

Dr. Sarah Al-Mutairi

Lead Surgeon

Received By

Patient / Representative

Date:

⬇️ Download as DOCX Edit online as DOCX

Create your own Word template with our GoGPT AI prompt:

GoGPT