Medical Invoice Template

Downloads: 3,434

The medical invoice template is used to bill a past patient for a medical service or examination performed. This invoice is designated for doctors, physicians, therapists, psychologists, psychiatrists, and any other licensed health care professionals. Most medical bills have a payment period of thirty (30) and sixty (60) days.

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HIPAA Requirements

Summary of Privacy Rules – Due to HIPAA requirements, only certain information may be entered on the invoice. Make sure that any medical procedures listed do not specifically state the procedure that was performed due to patient privacy laws. Make sure to write a generic description.

How to Write in PDF & MS Word

DownloadAdobe PDF or Microsoft Word

1 – The Medical Invoice On This Page Can Be Used To Bill A Patient For A Variety Of Services

The “Adobe PDF” links on this page will each lead to the Medical Invoice Template. This template will require some information regarding the provider, the patient, and what the charges the patient must pay.

2 – Clearly State The Sender’s Information

This document can be used by several different medical entities (i.e. Doctors, Labs, Therapists, etc.). Regardless of the entity type, the Legal Name of the Medical Business should be presented where the words “Company Name” are located. Next, we will need to present the official Mailing Address and Contact Information of the Medical Entity sending this document. The Full Name of the individual who can represent the Medical Entity to the Patient regarding this paperwork should be presented on the first blank space (“Name”). The Medical Entity’s Mailing Information will need to be presented using the next three blank lines (“Street Address,” “City,” “State,” “Country,” “ZIP Code”). In addition, make sure you deliver the Medical entity’s Contact Number and E-Mail Address on the next two lines.

3 – The Medical Invoice Number And Invoice Date Must Be Made Available To The Patient

Most Invoices will have a reference or record number originated purely for keeping track of the document in a filing system. A specific area has been set aside for this information. Fill in the Invoice Number for the transactions defined here along with the Invoice Date to the blank lines “Invoice #” and “Date” accordingly. 

4 – Define The Patient’s Billing Information

The Name and Mailing Address where the Patient has indicated he or she wishes Invoices sent should be recorded under “Bill To.” A few labeled lines have been supplied to act as a guide when inputting this information. Note: “Street Address” refers to the Building Number, Street Name, and Apt Suite Number or P.O. Box. You may insert the second line if you wish to list the Patient’s Unit Number separately.

5 – Give A General Description Of Medical Supplies And/Or Services The Patient Is Responsible For

Now we will have an opportunity to record the basis for the dollar amount the Patient must pay. We can easily deliver such information by filling out the appropriate tables below. We can use the “Products” table to name all the ordered medical items or supplies the Patient must pay for, how many of each was ordered, and the “Unit Cost” for each ordered good. The “Amount” column will give us an area where we can provide the patient with a summary for everything ordered. On each row, multiply the “Quantity” you reported with the “Unit Cost” entered. These numbers, in turn, should be added together with the sum reported in “Total Products.”

If the Patient must pay for services (i.e. a check-up, physical therapy, dialysis, etc.) then we should give a general break down by describing the provided service in the “Description” column of the “Labor” table, the number of “Hours” being billed, and the “Hourly Rate” that will apply to those Hours. Once this information has been submitted, multiply the number of “Hours” by the “Hourly Rate” (by row) then record the result in “Amount” on the same row. Also, add all the numbers entered in the final column then, present the result in “Total Labor.”

5 – Conclude The Medical Invoice With A Summary Of The Charges And Terms

Now that we have given a general description of the charges the Patient is responsible for, we should sum up these charges. To begin, add the “Total Products” box to the “Total Labor” box, then place the resulting sum in “Subtotal.” The Patient should also be told how much Taxes he or she must pay for this Invoice. Supply this amount in the box designated with the word “Tax.” Finally, record the sum of “Subtotal” and “Tax” in the box labeled “Total.” If the Patient only has a certain number of days to pay this Invoice before being considered delinquent, then you must provide this number in the statement “Payment Due In” Additional Comments, Information, Instructions, and/or Disclosures should be delivered using the two blank lines after the words “Comments Or Special Instructions.”


How to Write in MS Excel (.xlsx)

DownloadMicrosoft Excel (.xlsx)

1 – Obtain The Medical Invoice Template As An Excel Spreadsheet

The Invoice presented here serves to inform a patient that he or she owes a payment to a Medical Entity. You can gain access to a reusable copy by selecting the Excel button above or the link “MS Excel

2 – The Concerned Medical Provider And Patient Will Need To Be Documented

The Medical entity seeking payment should make sure its Logo and Legal Name are both clearly visible at the top of the page. Cells A1 and A2 have been reserved so that you may populate their contents with the Logo and Name of the Medical Entity, Office, or Provider sending this paperwork. The individual the Patient should contact when wishing to correspond with this Medical Entity should also be documented. Supply the Full Name of this contact to cell A3. The rest of the cells in this column (A4, A5. and A6) call for the Mailing Address of the Medical Entity. Continue filling in the Medical Provider’s information by supplying its E-Mail Address and Telephone Number to cells A17 and A8. The next cells that require direct attention are under the bold words “Bill To.” Cells A11 through A14 will accept the Name and Address.

3 – Produce The Filing Reference Used For This Paperwork

Find the cells on the right side of this spreadsheet F4 and H4. Use these two cells to give the Patient the “Invoice #” and Invoice “Date” for this document. These two items will serve as a reference point when discussing and storing this paperwork.

4 – The Medical Products And The Medical Services The Patient Required Should Be Accounted For

The Medical Items (i.e. supplies, medication, etc.) will need to be outlined when submitting this Invoice. You should keep in mind that only a general description of the items should be discussed on paper when invoicing (to comply with HIPPA regulations when doing so).

Use the “Description” column to give the patient a general idea of what he or she must pay for then record how many units the Patient ordered and what the “Unit Cost” of just one of these items in the second or third columns (respectively). This information will contribute to the last column thus completing the table automatically. In addition to any ordered or required items, we will need to give a detail on the Medical services provided by tending to the “Labor” table. Again, it will be best to use a general statement when describing the Medical services provided. Use the “Description,” “Hours,” and “$/Hours” to explain what the Patient is being charged for, the number of “Hours” the Patient is responsible to pay for, and the Hourly Rate that will be charged for these Medical services. The remainder of this table will use the figures you enter to give a report on what the total owed for each service is and what is owed for all services combined.

One more dollar amount will be required to complete this information. In cell H34, enter the total amount in Taxes the Patient must pay. Now that we have finalized the total amount due from the patient, we should give a time-frame describing when a payment should be made. The starting day should be the day of the Patient receives this Invoice. Bearing this in mind, record how many days the Patient has to pay this Invoice from the starting day, in H35. Supply all relevant comments in cell H38.


Downloads: 3,434