Invoice
Invoice No: #935648
Date: 22/03/2023
Invoice To:
Alex Farnandes
450 E 96th St, Indianapolis,
WRHX+8Q IN 46240,
United States
450 E 96th St, Indianapolis,
WRHX+8Q IN 46240,
United States
Invar Hospital:
4510 E 96th St, Indianapolis,
IN 46240, Inoba, Austona
info@Invarhospital.com
+153 6547 3698
IN 46240, Inoba, Austona
info@Invarhospital.com
+153 6547 3698
Patient Information:
| Patiend Name: | Alex Farnandes | Patient ID: | 123456789 |
| Patient Age: | 35 Years | Service: | Blood Test |
| Due Date: | 27/07/2022 | Insurence Billed: | WPS |
| Address: | 4 Balmy Beach Road, Owen Sound, Ontario, Canada | ||
| SL | Item Descriptions | Price | Tax | Amount |
|---|---|---|---|---|
| 01 | Blood Test | $250.00 | 10% | $275.00 |
| 02 | Test Kit | $15.00 | 2% | $15.30 |
| 03 | Consultant Surgeon Fee | $20.00 | 0% | $20.00 |
| 04 | Medical Hospital Supply | $25.00 | 0% | $25.00 |
| 05 | Nursing Service Charge | $30.00 | 0% | $330.00 |
| Total Amount: | $365.30 | |||
Payment Info:
Account : 1234 5678 9012
A/C Name : Alex Farnandes
| Paid: | $545.00 |
|---|---|
| Balance Due: | $00.00 |
NOTE: This is computer generated receipt and does not require physical signature.