Invoice Surgeon in Spain Madrid –Free Word Template Download with AI
Dr. Alejandro Ruiz, MD, PhD
Specialist Surgeon - General & Laparoscopic Surgery
Calle de Alcalá, 123, 4º Izquierda
28009 Madrid, Spain
NIF: B-12345678
Phone: +34 91 123 45 67
Email: [email protected]
Invoice Number: INV-2023-10-045
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Payment Terms: Net 30 Days
Bill To (Patient)
Mr. Carlos Fernandez Lopez
Calle de Serrano, 45, 2ºD
28001 Madrid, Spain
NIF: 12345678Z
Phone: +34 600 123 456
Insurance / Third Party Payer
Sanitas Salud S.A.
Av. de la Constitución, 10
28027 Madrid, Spain
Policy Number: SAN-99887766
Group Code: GRP-MAD-001
| # | Description of Surgical Services | Date of Service | Qty | Unit Price (EUR) | Total (EUR) |
|---|---|---|---|---|---|
| 1 |
Pre-operative Surgical Consultation Comprehensive evaluation by Dr. Ruiz in Madrid clinic. Includes review of medical history, physical examination, and surgical planning discussion. |
Oct 10, 2023 | 1 | 150.00 | 150.00 |
| 2 |
Laparoscopic Cholecystectomy (CPT 47601) Surgical removal of the gallbladder performed by the Surgeon using minimally invasive techniques. Includes anesthesia coordination and operating room time. |
Oct 15, 2023 | 1 | 2,500.00 | 2,500.00 |
| 3 |
Operating Room Facility Fees Usage of surgical suite at Centro Quirúrgico Madrid. Includes sterilization, medical equipment, and nursing staff support during the procedure. |
Oct 15, 2023 | 1 | 800.00 | 800.00 |
| 4 |
Post-operative Pathology Analysis Histological examination of the removed tissue sample conducted by certified laboratory in Madrid to confirm diagnosis. |
Oct 16, 2023 | 1 | 200.00 | 200.00 |
| 5 |
Post-operative Follow-up Visit Surgical wound check and recovery assessment by the Surgeon. Includes prescription renewal and discharge instructions. |
Oct 22, 2023 | 1 | 100.00 | 100.00 |
| 6 |
Medical Supplies and Consumables Laparoscopic instruments, sutures, dressings, and disposable materials used during the surgical intervention in Spain. |
Oct 15, 2023 | 1 | 350.00 | 350.00 |
Important Notes & Payment Instructions
This invoice represents the professional fees charged by the Surgeon, Dr. Alejandro Ruiz, and the facility costs associated with the surgical procedure performed in Madrid, Spain. All prices are quoted in Euros (EUR).
Payment Methods:
Bank Transfer (IBAN): ES12 3456 7890 1234 5678 9012
Bank Name: Banco Santander S.A., Madrid Branch
SWIFT/BIC: BSCHESMM
Please include the Invoice Number (INV-2023-10-045) as the reference for your payment. Late payments may incur a penalty interest rate of 1.5% per month as per Spanish commercial law regulations.
If you have any questions regarding this invoice or the surgical services provided, please contact our billing department in Madrid during business hours (Monday to Friday, 9:00 AM - 6:00 PM CET).
Authorized Signature
Dr. Alejandro RuizLead Surgeon
Centro Quirúrgico Madrid ⬇️ Download as DOCX Edit online as DOCX
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