The medical billing invoice template is a readymade layout that can be useful for pharmaceutical sale as well as for detailing other medical costs. The billing invoice is sent to the customer or patient who will need to pay the required payment within a stipulated period of time for the medical services rendered. This clearly elaborates the information about each services rendered to the customer along with the expenses incurred by him. Thus, such a template must be created with utmost proficiency and with ample provision for detailing every billing minutes. Moreover, it must be structured in a simple and coherent manner for the patient to understand properly.
You can Download the Free Medical Billing Invoice Template form, customize it according to your needs and Print. Medical Billing Invoice Template is either in MS Word, Excel or in PDF.
Sample Medical Billing Invoice:
Medical Billing Invoice
Invoice no.____________________ [specify an unique code for invoice reference]
|Patient’s Name:___________________________ [State the name of the patient for whom the invoice is being made]Age:______Gender: [Male/Female]Address:_________________________ [Specify the correct address of the patient for future need]_________________________________
Phone no. ________________
|Consultant Physician/Doctor:_____________ [State the name of the doctor who has provided the diagnosis]Health Facility:____________________ [State the name of the health care institution]Date of Invoice:_______________________ [state the date on which the invoice was dispatched]|
|Patient’s Payment Preferences:Medical Insurance (if any):____________ [State the nature of insurance policy the customer has opted for and the amount of expenses that would be covered under the same.]IP no. :[In case the insurance policy does not suffice]
Mode of payment:
Bank Account no.:______________
[Provide the necessary information regarding the different expenses incurred by the patient]
|Services Provided/ Medical Supplies Sold||Amount|
|Sub total:____________Tax:______________Grand Amount:_________________|
|Signature of Cashier:______________Signature of Patient:________________|