Invoice Surgeon in South Africa Johannesburg –Free Word Template Download with AI
Consultant General & Laparoscopic Surgeon
Medical Practitioner Council of South Africa (HPCSA) Reg: 0459821
SANAS Accredited Surgical Centre
142 West Street, Sandton, Johannesburg, 2196
South Africa
Tel: +27 (0)11 555 0199 | Email: [email protected]
Billed To (Patient)
Mr. James D. Van Der Merwe
45 Rivonia Road, Parktown
Johannesburg, Gauteng, 2193
South Africa
ID Number: 850412 5009 087
Bill To (Medical Scheme)
Discovery Health (Pty) Ltd
Plan: Premier Plan
Member Number: 10029384756
Dependent Number: 01
Claim Reference: CLM-2023-99210
Service Description & Clinical Context
This invoice represents the professional fees charged by the Surgeon for surgical intervention performed at the Netcare Milpark Hospital, located in the heart of Johannesburg, South Africa. The procedure was necessitated by acute appendicitis confirmed via CT imaging. The Surgeon performed a Laparoscopic Appendectomy under general anaesthesia.
In accordance with the Medical Schemes Act of South Africa and the prescribed fees for the region, this document itemizes the surgeon's professional fees, including pre-operative consultation, the surgical procedure itself, and post-operative follow-up care. The Surgeon adheres to the highest standards of medical practice as regulated by the Health Professions Council of South Africa (HPCSA). All services rendered were conducted within the metropolitan area of Johannesburg, utilizing state-of-the-art facilities available in Gauteng.
| Date | Description of Surgical Services | Medical Scheme Code | Amount (ZAR) | VAT (15%) |
|---|---|---|---|---|
| 10 Oct 2023 | Initial Surgical Consultation & Assessment in Johannesburg Clinic | 0001 | R 1,200.00 | R 180.00 |
| 12 Oct 2023 | Pre-operative Patient Evaluation & Consent Documentation | 0002 | R 850.00 | R 127.50 |
| 12 Oct 2023 | Laparoscopic Appendectomy (Complex) - Surgeon's Fee | 0459 | R 18,500.00 | R 2,775.00 |
| 12 Oct 2023 | General Anaesthesia Coordination & Surgical Time | 0460 | R 4,200.00 | R 630.00 |
| 13 Oct 2023 | Post-operative Ward Visit & Wound Check (Day 1) | 0003 | R 950.00 | R 142.50 |
| 14 Oct 2023 | Post-operative Ward Visit & Discharge Planning (Day 2) | 0003 | R 950.00 | R 142.50 |
| 20 Oct 2023 | Follow-up Consultation at Sandton Surgery Centre | 0001 | R 1,100.00 | R 165.00 |
Payment Instructions & Banking Details
Please settle the outstanding balance within 30 days of the invoice date. Payments can be made via Electronic Funds Transfer (EFT) to the following bank account in South Africa:
Bank: First National Bank (FNB)
Branch: Sandton, Johannesburg
Account Name: Dr. T. Mokoena Surgical Trust
Account Number: 6299887766
Account Type: Cheque Account
Reference: INV-JHB-2023-8842 / Van Der Merwe
Note: This invoice is subject to the laws of South Africa. Any disputes regarding the Surgeon's fees must be raised within 14 days of receipt. This document serves as a valid tax invoice for VAT purposes.
Authorized By:
Dr. Thabo Mokoena
Lead Surgeon
Received By:
__________________________
Date: ____________________
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