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: INV2025-004
Visit ID: VID12350
Type of Payment Mode: Insurance
Date: 17 July 2025

Invoice To:

Patient Name: Jennifer Brown [CHR001]
Mobile: +1 (555) 345-6789
Address: 987 Maple Drive, Cityville, State

Invoice : Insurance

S.No.Item CodeItem DescQtyGross Amount ($)Discount ($)Patient Share ($)Tax Amount ($)Net Bill ($)
1MED207ECG Test1100.0080.0020.000.0020.00
2MED208Basic Blood Panel1180.00150.0030.000.0030.00
Total280.00230.0050.000.0050.00
Billed By: EMP1103
Status: Paid
Net Tax collection: 0.00
Payment Method Used: Insurance
Payment Txn number: CC050**
Amount in Words: We have received the net amount of $50.00 via charity fund assistance
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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