Medical Invoice Template

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Download the medical invoice template to request payment for medical services. Make sure to adequately identify the services provided with any special terminology, codes, and any other information that insurance companies would need.

How to Make in Adobe PDF and Microsoft Word

Step 1 – Download in Adobe PDF (.pdf) or Microsoft Word (.doc).

Step 2 – Start with the invoice number at the top, and then enter your practice’s contact information, including telephone and fax numbers. Enter the patient’s contact information to the right.

Step 3 – Write in the patient’s physical information at the top table, including weight and height, along with the date examined.

Step 4 – Enter each different service on a separate row in the table, and enter any medication prescribed as a result to the left. Then fill in the rate for each service and the total for each by multiplying the number of times a service was provided by its rate. Add the total column together to get the total amount the patient owes, and specify whom to make checks payable to at the bottom.

How to Make in Microsoft Excel

Step 1 – Download in Microsoft Excel (.xls).

Step 2 – Enter your practice’s name and contact information at the top, and then include the date of invoice and the invoice number to the right.

Step 3 – Bill To – Fill in the patient’s billing address here and write their name to the right. In the small table below, enter the name of the doctor who attended the patient, the due date of payment, and any payment terms such as the payment method.

Step 4 – In the main table, enter the date of each service to the left, then a description of the service in the next column, along with the total cost and the co-pay the patient owes in the next two columns. In the next column, show how much of the cost the insurance company will reimburse. Include any adjustments in the column to the right of that, and then write the balance the client owes your practice in the balance column. Add each figure in each column and enter the totals at the bottom.

Step 5 – If needed, enter the payment type below and include the credit card information if the customer is paying with credit. Add any notes at the bottom if necessary.