Printable Sample Medical Bill Invoice

A sample medical bill invoice template is a document which provides a format to elaborate summary of the charges and expenses incurred on the services used by a patient’s family in trying to treat and cure the patient. It is a bill of record as well as payment issued generally by the hospital authorities. The bill shows the unit costs and the covered costs in a simplistic manner by taking into account the amount and time of service supplied to the patient. The invoice of the services is then modified based on the medical claims of the patient, advance payments made and taxes to produce the final amount. The admission and discharge dates must be put in for valid calculation.

Sample Printable Medical Bill Invoice Template

Sample Medical Bill Invoice Template

Download Sample Medical Bill Invoice Template

MEDICAL BILL INVOICE

COMPANY LOGO[Indicate the symbol] Name of the health organization: _____________ [Provide the name of the hospital/clinic/health-centre]Address: ______ [Mention address]       Phone: _____ [Mention call number]
Date of issue: _________ [Mention date of generating invoice]Due date: _________ [Mention last date of payment]
Patient’s Name: _____________ [Mention full name of the concerned person]Gender: _____ [Indicate gender male/female]             Age: _____ [Indicate age in Years]Address: _____________ [Mention full address]Contact: _________ [Mention his/her contact]
Date of admission: _______ [Mention date]Date of discharge: ________ [Mention date]
Consultant’s Name: _____________ [Mention full name of the concerned doctor]Contact: __________ [Mention his private number]

Service

Description

Duration

Unit Cost

Total Amount

Terms and Conditions: Subtotal:                     Tax Amount:  Discounted Amount:
Total Due: ______________ [Mention due amount in words]Payment mode: __________ [Mention payment type] Signature: _________Signature: _________

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