Invoice Surgeon in Sudan Khartoum –Free Word Template Download with AI
Specialized Surgical & Medical Services
Al-Amarat District, Khartoum, Sudan
P.O. Box 12345
Tel: +249 183 123 456
Email: [email protected]
License No: KH-SURG-2023-889
Invoice #: INV-2023-10-045
Date: October 24, 2023
Due Date: November 07, 2023
Status: Pending Payment
Bill To:Patient Name: Ahmed Mohamed Hassan
Address: 45 Al-Nil Street, Bahri, Khartoum North, Sudan
National ID: 1234567890
Insurance Provider: Sudan National Health Insurance (Policy #SNHI-9988)
Service Provider:Lead Surgeon: Dr. Fatima Ibrahim, MD, FACS
Specialty: General & Laparoscopic Surgery
Medical Council Registration: SMC-REG-4455
Description of Surgical Services Rendered| Item | Description | Date | Amount (SDG) |
|---|---|---|---|
| 1 |
Pre-Operative Consultation & Assessment Comprehensive evaluation by the Lead Surgeon in Khartoum. Includes review of medical history, physical examination, and surgical planning. |
Oct 18, 2023 | 15,000.00 |
| 2 |
Diagnostic Imaging & Lab Work Abdominal Ultrasound, Complete Blood Count (CBC), Coagulation Profile, and ECG required for surgical clearance at Nile Valley Labs. |
Oct 19, 2023 | 25,000.00 |
| 3 |
Laparoscopic Cholecystectomy Procedure Surgical removal of the gallbladder performed by Dr. Fatima Ibrahim. Includes use of laparoscopic equipment and surgical team assistance. |
Oct 20, 2023 | 180,000.00 |
| 4 |
Anesthesia Services General anesthesia administration and monitoring by certified anesthesiologist during the surgical procedure. |
Oct 20, 2023 | 45,000.00 |
| 5 |
Operating Room Facility Fee Usage of sterile operating theater, nursing staff, and sterilization services at the Khartoum facility. |
Oct 20, 2023 | 60,000.00 |
| 6 |
Post-Operative Hospital Stay (2 Nights) Ward accommodation, nursing care, and vital sign monitoring following surgery. |
Oct 20-22, 2023 | 40,000.00 |
| 7 |
Pharmaceuticals & Consumables Antibiotics, pain management medication, IV fluids, and surgical dressings provided during hospitalization. |
Oct 20-22, 2023 | 35,000.00 |
| 8 |
Post-Operative Follow-Up Consultation Wound check and recovery assessment by the Surgeon. |
Oct 24, 2023 | 10,000.00 |
Please remit payment within 14 days of the invoice date. Payments can be made via bank transfer or cash at the hospital reception in Khartoum.
Bank Name: Bank of Khartoum
Branch: Al-Amarat Main Branch
Account Name: Nile Valley Surgical Center
Account Number: 1001234567890
SWIFT Code: BKHRTDXX
Terms and Conditions:
- This invoice represents the final bill for the surgical services rendered by the Surgeon at the Nile Valley Surgical Center in Khartoum, Sudan.
- Late payments may incur a penalty fee of 2% per month on the outstanding balance.
- Please quote the Invoice Number (INV-2023-10-045) on all correspondence and payments.
- Disputes regarding charges must be raised within 30 days of receiving this invoice.
- This document serves as an official receipt for tax and insurance purposes within the Republic of Sudan.
Authorized Signature
Dr. Fatima Ibrahim
Lead Surgeon
Received By
Ahmed Mohamed Hassan
Date: _______________
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