Invoice Surgeon in Vietnam Ho Chi Minh City –Free Word Template Download with AI
123 Nguyen Hue Boulevard, District 1
Ho Chi Minh City, Vietnam
Tax Code: 0312345678
Phone: +84 28 3822 1234 | Email: [email protected]
Invoice Number: INV-2023-10-089
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Service Provider (Surgeon)
Dr. Nguyen Van Minh, MD, FACS
Chief of General Surgery
Licensed Medical Practitioner in Vietnam
Specialization: Minimally Invasive & Laparoscopic Surgery
Bill To (Patient)
Mr. John Doe
456 Le Loi Street, District 3
Ho Chi Minh City, Vietnam
ID/Passport No: AB1234567
Insurance Provider: Vinamcare International
| # | Description of Surgical Services | Date of Service | Unit Price (VND) | Total Amount (VND) |
|---|---|---|---|---|
| 1 |
Pre-operative Surgical Consultation Comprehensive evaluation by the Surgeon regarding the patient's condition, review of medical history, and surgical planning. Includes diagnostic imaging review. |
Oct 10, 2023 | 2,500,000 | 2,500,000 |
| 2 |
Laparoscopic Cholecystectomy (Surgeon's Fee) Professional fee for the Surgeon performing the minimally invasive removal of the gallbladder. This includes the technical skill, time, and expertise required during the procedure at the Ho Chi Minh City International Surgical Center. |
Oct 15, 2023 | 15,000,000 | 15,000,000 |
| 3 |
Anesthesia Coordination & Monitoring Coordination with the anesthesiologist to ensure patient safety during the surgical procedure. Includes pre-anesthesia assessment and intra-operative monitoring. |
Oct 15, 2023 | 4,500,000 | 4,500,000 |
| 4 |
Operating Room Facility Fee Usage of the sterile surgical suite, medical equipment, and nursing staff support during the operation. |
Oct 15, 2023 | 8,000,000 | 8,000,000 |
| 5 |
Post-operative Surgeon Follow-up Immediate post-surgical care, wound inspection, and management of recovery protocols. Includes two follow-up visits within 14 days to ensure proper healing. |
Oct 16, 2023 | 3,000,000 | 3,000,000 |
| 6 |
Pharmaceuticals & Consumables Antibiotics, pain management medication, and surgical disposables used during the procedure. |
Oct 15, 2023 | 2,000,000 | 2,000,000 |
Amount in words: Thirty-three million five hundred thousand Vietnamese Dong only.
Payment Terms & Important Notes
This Invoice represents the professional fees and associated costs for surgical services rendered by the Surgeon at our facility in Ho Chi Minh City, Vietnam. Payment is due within 30 days of the invoice date.
Bank Transfer Details:
Bank Name: Vietcombank - Ho Chi Minh City Branch
Account Name: Ho Chi Minh City International Surgical Center
Account Number: 0071001234567
SWIFT Code: BFTVVNVX
Please reference the Invoice Number (INV-2023-10-089) when making your payment. If you have any questions regarding the charges or the surgical procedure performed by the Surgeon, please contact our billing department immediately.
Legal Notice: This document serves as a legal record of the transaction under the laws of Vietnam. All medical services were provided in accordance with the standards of the Ministry of Health of Vietnam.
Authorized by (Surgeon)
Dr. Nguyen Van Minh
Signature & Stamp
Received by (Patient)
Mr. John Doe
Signature & Date
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