Invoice No: #12345
Must Read:
Lorem Ipsum is simply dummy text of the printing and typesetting industry. Lorem Ipsum has been the industry.
Date of Service : 11-05-2022
Front Webs Hospital
03, PQR Street, Kamrej
Surat, India
blueline@contact.com
Patient Name:
Jenny Maldiv
Patient Number:
+1 5658-5654-565
Patient Address:
Lorem Ipsum is simply dummy text
Patient Birth Date:
24 Year Old - 11-05-1998
Services:
Eye Check Up
Insurence (Yes/No):
YES
Due Date:
19-05-2022
| Details | Charges | Amount |
|---|---|---|
| Eye Treatment | $60.00 | $60.00 |
| Bed Charge | $120.00 | $120.00 |
| Surgeon Fee | $25.00 | $25.00 |
| Medical Hospital Supply | $50.00 | $50.00 |
| Nursing Service Charge | 100.00 | $100.00 |
| Sub Total: | $335.00 | |
Note:
Please Write Additional Information note for the client to get
a better understaing pf this invoice