Free Printable Medical Invoice

The medical invoice template is a useful and necessary pre-developed document that is used by a hospital authority, for the purpose of detailing the charge incurred by a patient on receiving medical services. The template must provide adequate lineation for incorporating information related to doctor’s fees, medical tests, medicines etc.  Such kind of template is readily available in free over the internet containing general lineation for depicting any kind of medical invoice. However, this kind of free medical invoice template can be customized according to the requirements and purpose for which it is being used. Therefore, it is also important to choose a proper medical invoice template so that it could effectively suit the need.

You can Download the Free Free Medical Invoice Templatee form, customize it according to your needs and Print. Free Medical Invoice Template is either in MS Word, Excel or in PDF.

Sample Printable Free Medical Invoice Template:

Free Medical Invoice Template

Download Free Medical Invoice Template

___________________Medical Invoice
[State the name of the healthcare organization]
____________________________________ [Provide a mission statement of the particular organization at the header part]

Invoice Date: _____________________[dd/mm/yy]
Invoice Number: ___________________Contact Information : [State the required contact details of the health care organization]Address: _____________________
_______________________________Phone no.:____________
Patient Information:Name of the Patient: ____________________________Address:_______________________Age:

Gender: [Male / Female]

 

Department:      [State the hospital department in which the patient is admitted or undergoing check-up.]

Bed/Ward Number:

Doctor in Charge: ______

Admission Date:_______ [dd/mm/yy]

 

Date of Discharge:_______

Payment Details: [Specify the mode through which the patient is paying off the bill.]Mode: 

Bank Account no.:

 

Invoice Details: [Specify the details of the services rendered along with the expenses incurred by the patient.]
Services Charge Amount
Discount:Service Tax:Total Amount:
Signature: [Provide the signature of the hospital-in-charge]

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>