Invoice Surgeon in United Arab Emirates Abu Dhabi –Free Word Template Download with AI
License No: DHA-ABU-2023-8842
Address: Al Reem Island, Tower B, Level 4, Abu Dhabi, United Arab Emirates
Phone: +971 2 555 0199
Email: [email protected]
VAT Registration: AE 100 234 567 8000
Invoice Number: INV-AD-2023-10-459
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Payment Method: Bank Transfer / Credit Card
Bill To:
Patient Name: Mr. Ahmed Al-Mansoori
Emirates ID: 784-1990-1234567-8
Address: Khalifa City A, Villa 45, Abu Dhabi, United Arab Emirates
Phone: +971 50 123 4567
Insurance Provider: Daman Insurance (Policy: DAM-998877)
Service Description: Professional Surgeon Fees
This invoice details the professional fees charged by the attending Surgeon for the surgical procedure performed at the Abu Dhabi Advanced Surgical Center. The services rendered comply with the regulations set forth by the Department of Health – Abu Dhabi (DoH). The Surgeon, Dr. Sarah Al-Fayed, is a board-certified specialist in Orthopedic Surgery.
| # | Description of Service | Date | Unit Price (AED) | Total (AED) |
|---|---|---|---|---|
| 1 |
Pre-Operative Consultation & Assessment Comprehensive evaluation by the Surgeon to determine surgical necessity and plan the procedure. Includes review of medical history and imaging. |
Oct 10, 2023 | 1,500.00 | 1,500.00 |
| 2 |
Primary Surgical Procedure: Arthroscopic Knee Repair Professional fee for the Surgeon's time, skill, and expertise during the operation. Includes intraoperative decision-making and technical execution. |
Oct 15, 2023 | 15,000.00 | 15,000.00 |
| 3 |
Assistant Surgeon Fee Professional fee for the assisting Surgeon during the procedure to ensure optimal patient safety and surgical outcomes. |
Oct 15, 2023 | 3,500.00 | 3,500.00 |
| 4 |
Post-Operative Immediate Care Surgeon's supervision and care in the recovery room immediately following the surgery. |
Oct 15, 2023 | 2,000.00 | 2,000.00 |
| 5 |
Follow-Up Consultation (First Visit) Post-surgical check-up to assess healing progress, remove sutures if necessary, and adjust rehabilitation plan. |
Oct 22, 2023 | 800.00 | 800.00 |
| 6 |
Medical Report & Documentation Preparation of detailed surgical reports for insurance and medical records as required by UAE health authorities. |
Oct 23, 2023 | 500.00 | 500.00 |
Terms and Conditions:
1. Payment is due within 30 days of the invoice date. Late payments may incur a penalty as per UAE commercial law.
2. This invoice covers professional Surgeon fees only. Hospital facility fees, anesthesia, and medication are billed separately.
3. Please quote the Invoice Number on all payments.
4. For insurance claims, please submit this invoice along with the medical report to your provider.
5. All services were rendered in accordance with the standards of the United Arab Emirates Abu Dhabi healthcare regulations.
6. Bank Details for Transfer:
Bank: Emirates NBD
Account Name: Abu Dhabi Advanced Surgical Center
IBAN: AE07 0331 2345 6789 0123 456
SWIFT: ENBD AEAD
Authorized Signature
Dr. Sarah Al-Fayed
Lead Surgeon
Received By
________________________
Date: ___________________
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