A1 Hospital

123 Main Street, Cityville, State, 123456

Contact: +1 (555) 123-4567 | Website: www.A1hospital.com

Appointment Line: +1 (555) 000-1234

A1 Hospital

123 Main Street, Cityville, State, 123456

Contact: +1 (555) 123-4567 | Website: www.A1hospital.com

Invoice Details:

Invoice No: INV2025-008
Visit ID: VID12354
Type of Payment Mode: Insurance
Date: 13 July 2025

Invoice To:

Patient Name: Lisa Anderson
Mobile: +1 (555) 890-1234
Address: 741 Aspen Court, Cityville, State

Invoice : Insurance

S.No.Item CodeItem DescQtyGross Amount ($)Discount ($)Patient Share ($)Tax Amount ($)Net Bill ($)
1MED214Cardiology Consultation1300.0045.0051.0012.75318.75
2MED215Stress Test1450.0050.0080.0020.00420.00
Total750.0095.00131.0032.75738.75
Billed By: EMP1107
Status: Paid
Net Tax collection: 0.00
Payment Method Used: Insurance
Payment Txn number: GG738**
Amount in Words: We will proceed the net outstanding of $738.75 with patient's Insurance
For: A1 Medical Center

Disclaimer: This is a system-generated invoice copy and does not require any seal or signature. In case of any changes in the billed services or amount, the final invoice can be verified using our app. Any excess amount paid in cash or card will be kept in the patient account. For further assistance, contact our support team.

Thank you for visiting our facility. We wish you a healthy life with us.

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