Invoice Surgeon in Uganda Kampala –Free Word Template Download with AI
Lead Surgeon: Dr. Sarah Nakato, MBChB, FCPS (Surgery)
Plot 45, Kololo Hill Drive, Kampala, Uganda
Tel: +256 414 123 456 | Email: [email protected]
TIN: 1234567890 | URA Reg: URA-2023-9988
Invoice #: INV-UG-2023-0045
Date: October 24, 2023
Due Date: November 24, 2023
Status: PENDING
Bill To:
Mr. James Okello
Plot 12, Nakasero Road
Kampala, Uganda
ID No: UG-88776655
Phone: +256 772 999 888
Insurance / Third Party Payer:
Uganda Medical Insurance Ltd.
Policy No: UMI-2023-5544
Group ID: G-998877
Reference: Claim #CLM-2023-1122
This invoice represents the professional fees and associated costs for surgical services rendered by a qualified Surgeon at our facility in Uganda Kampala. The procedures were conducted in accordance with the standards set by the Uganda Medical and Dental Practitioners Council.
| # | Description of Services | Date | Qty | Amount (UGX) |
|---|---|---|---|---|
| 1 |
Pre-Operative Consultation & Assessment Comprehensive evaluation by the Surgeon, including medical history review, physical examination, and surgical planning. |
Oct 10, 2023 | 1 | 350,000 |
| 2 |
Laparoscopic Cholecystectomy (Gallbladder Removal) Surgical procedure performed by Dr. Nakato. Includes anesthesia coordination, operating theater usage, and surgical team fees. |
Oct 15, 2023 | 1 | 4,500,000 |
| 3 |
Post-Operative Care & Monitoring 48-hour intensive monitoring, wound dressing, and pain management administered by nursing staff under Surgeon supervision. |
Oct 16, 2023 | 2 | 1,200,000 |
| 4 |
Diagnostic Imaging & Lab Work Pre-surgery blood panel, ultrasound, and post-surgery X-ray to ensure successful recovery. |
Oct 11, 2023 | 1 | 450,000 |
| 5 |
Pharmaceuticals & Consumables Antibiotics, analgesics, IV fluids, and surgical disposables used during the procedure in Uganda Kampala. |
Oct 15, 2023 | 1 | 600,000 |
| 6 |
Follow-Up Consultation Post-discharge review by the Surgeon to assess healing progress and provide discharge instructions. |
Oct 22, 2023 | 1 | 200,000 |
Payment Instructions:
Please remit payment within 30 days of the invoice date. Payments can be made via bank transfer or mobile money (MTN/Airtel) as per the details below.
Bank Name: Stanbic Bank Uganda Ltd.
Branch: Kampala Road Branch
Account Name: Apex Surgical Specialists Ltd.
Account Number: 1001234567890
Sort Code: 001
Reference: INV-UG-2023-0045
For mobile money payments, please send to +256 772 123 456 and quote your Invoice Number.
Terms and Conditions:
- All services were rendered by a licensed Surgeon registered with the Uganda Medical and Dental Practitioners Council.
- Late payments will incur a penalty of 2% per month on the outstanding balance.
- This invoice is valid for tax purposes in Uganda and complies with URA regulations.
- Any disputes regarding this invoice must be raised within 14 days of receipt.
- Insurance claims should be submitted directly to the provider with a copy of this invoice.
Authorized By:
Dr. Sarah Nakato
Lead Surgeon
Received By:
________________________
Date: _________________
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