Invoice Veterinarian in United States New York City –Free Word Template Download with AI
Licensed Veterinarian Practice — Serving the United States New York City Community Since 1998
245 West 42nd Street, Suite 310, Midtown Manhattan, New York, NY 10036, United States New York City
Phone: (212) 555-0187 | Email: [email protected] | NYS Veterinary License No. VET-2024-08841
INVOICEOfficial Veterinarian Invoice
Invoice Details
Invoice Number: INV-2024-07-3392
Date of Service: July 14, 2024
Invoice Date: July 15, 2024
Due Date: August 14, 2024
Payment Terms: Net 30 Days
Prepared By: Dr. Sarah Mitchell, DVM, CVI
Billed To (Client)
Name: Mr. Jonathan R. Whitfield
Address: 1842 Lexington Avenue, Apt 12B
City, State, ZIP: New York, NY 10029, United States New York City
Phone: (917) 555-4421
Email: [email protected]
Client Account No.: CLT-2019-0447
Patient Information
Pet Name: Biscuit
Species / Breed: Canine / Golden Retriever
Age: 6 years, 4 months
Sex: Male (Neutered)
Weight: 72 lbs (32.7 kg)
Microchip No.: 985-112-003-447-821
Attending Veterinarian
Lead Veterinarian: Dr. Sarah Mitchell, DVM, CVI
Specialty: Internal Medicine & Orthopedics
Assisting Technician: Maria Gonzalez, LVT
Practice Location: United States New York City, Manhattan
Referring Veterinarian: N/A
| # | Description of Veterinarian Service | CPT / VBC Code | Qty | Unit Price (USD) | Amount (USD) |
|---|---|---|---|---|---|
| 1 | Comprehensive veterinary examination including full physical assessment, auscultation, palpation, and neurological screening performed by the attending Veterinarian | VBC 0101 | 1 | $185.00 | $185.00 |
| 2 | Digital radiography (4 views) of bilateral hind limbs for suspected cruciate ligament injury; imaging performed and interpreted by the Veterinarian | VBC 0210 | 1 | $320.00 | $320.00 |
| 3 | Complete blood count (CBC) and comprehensive metabolic panel (CMP) with veterinary pathology analysis | VBC 0305 | 1 | $145.00 | $145.00 |
| 4 | Ultrasonographic examination of abdominal cavity and pelvic region conducted by the Veterinarian for diagnostic evaluation | VBC 0225 | 1 | $275.00 | $275.00 |
| 5 | Intravenous fluid therapy (Lactated Ringer's Solution, 500 mL) administered under Veterinarian supervision for 4-hour duration | VBC 0410 | 1 | $95.00 | $95.00 |
| 6 | Prescription medication: Carprofen (Rimadyl) 75 mg tablets, 30-count supply; dispensed by the Veterinarian with written instructions | VBC 0520 | 1 | $68.00 | $68.00 |
| 7 | Prescription medication: Gabapentin 100 mg capsules, 60-count supply for post-operative pain management; dispensed by the Veterinarian | VBC 0520 | 1 | $54.00 | $54.00 |
| 8 | Annual rabies vaccination (3-year duration) administered by the Veterinarian; certificate of vaccination issued per New York State Department of Health regulations | VBC 0610 | 1 | $45.00 | $45.00 |
| 9 | Distemper-Parvo-Leptospirosis (DHLPP) booster vaccination administered by the Veterinarian | VBC 0610 | 1 | $55.00 | $55.00 |
| 10 | Follow-up consultation and wound check by the Veterinarian; includes suture inspection, range-of-motion assessment, and activity restriction counseling | VBC 0102 | 1 | $120.00 | $120.00 |
| 11 | Orthopedic surgical procedure: Tibial Plateau Leveling Osteotomy (TPLO) of the right hind limb, including pre-anesthetic evaluation, general anesthesia, surgical intervention, and post-operative monitoring by the Veterinarian and surgical team | VBC 0730 | 1 | $2,850.00 | $2,850.00 |
| 12 | Surgical supplies: TPLO implant kit (plate, screws, and fixation hardware), sterile surgical drapes, and suture materials | VBC 0815 | 1 | $410.00 | $410.00 |
| 13 | Post-operative hospitalization (24-hour stay) including continuous monitoring, IV fluid maintenance, pain management protocol, and overnight nursing care under Veterinarian oversight | VBC 0920 | 1 | $380.00 | $380.00 |
| 14 | Post-operative radiographic evaluation (2 views) to confirm proper implant placement, performed and interpreted by the Veterinarian | VBC 0210 | 1 | $180.00 | $180.00 |
| Subtotal | $5,282.00 |
|---|---|
| NYC Sales Tax (8.875%) | $468.78 |
| NYS Veterinary Service Surcharge | $0.00 |
| Insurance Adjustment (PetPlan) | -$1,245.50 |
| TOTAL DUE | $4,505.28 |
Accepted Payment Methods for This Veterinarian Invoice
- Check or Money Order payable to "Manhattan Animal Care & Veterinary Clinic"
- All major credit and debit cards (Visa, Mastercard, American Express, Discover)
- ACH bank transfer (routing and account numbers required)
- Cash (in-person payment at our United States New York City office only)
- Payment plans available for balances exceeding $1,000; contact our billing office for details
Remit to: Manhattan Animal Care & Veterinary Clinic, Attn: Accounts Receivable, 245 West 42nd Street, Suite 310, New York, NY 10036, United States New York City
Important Notes Regarding This Veterinarian Invoice
This Invoice has been prepared in accordance with the New York State Education Law, Article 137, governing the practice of veterinary medicine in the United States New York City and its surrounding jurisdictions. All services listed above were performed or supervised by a licensed Veterinarian holding an active New York State veterinary license.
Please review this Invoice carefully. If you have any questions regarding any line item, the procedures performed, or the charges assessed, please contact our billing department within 30 days of the Invoice date. Our team is available Monday through Friday, 8:00 AM to 6:00 PM Eastern Time, at (212) 555-0187.
A late payment fee of 1.5% per month will be applied to any balance remaining unpaid after the due date of August 14, 2024, as permitted under New York State commercial practice regulations. This fee is in addition to any interest or penalties assessed by your insurance provider.
Your pet's medical records, including all diagnostic imaging, laboratory results, and surgical reports referenced in this Invoice, are maintained in compliance with the Health Insurance Portability and Accountability Act (HIPAA) and New York State public health records statutes. You may request a complete copy of your pet's medical file at any time by submitting a written request to our records office.
This Veterinarian Invoice constitutes the final billing statement for all services rendered during the treatment period of July 14, 2024, through July 15, 2024. No additional charges will be incurred for the procedures listed herein unless otherwise communicated in writing by the attending Veterinarian prior to the performance of any additional service.
Thank you for entrusting your beloved companion to our care. Our entire team of Veterinarians, technicians, and support staff at this United States New York City practice is committed to providing the highest standard of animal healthcare in the metropolitan area. We look forward to continuing our relationship with you and Biscuit for many years to come.
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