Ambulance Service Invoice Template

Downloads: 2,021

Ambulance Service Invoice Template is an intrinsic part of the billing process when it is time to correspond with a Patient or Payer to request the amount payable for a delivered service. Usually, this only requires a minimum of information, especially since the nature of the service may be deemed sensitive to some. While this is a well-structured template, keep in mind, that some Payers may require more information than normally provided while others prefer less. This paperwork can be adjusted accordingly to the needs of the Service issuing it or the Payer receiving it.


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How to Write in PDF and Microsoft Word

Download In Adobe PDF or Microsoft Word (.docx)

1 – Download The Ambulance Service Invoice

The invoice required to bill for ambulance service should be obtained through the blue text above. If you wish to work with a PDF file, then select the text “Adobe PDF.” Otherwise, you can download a “Microsoft Word (.docx)” version by selecting the adjacent link.

 

2 – Identify The Ambulance Service

Once you have gathered the records required to request a payment, open the file you have obtained. The legal name of the Ambulance Service must be input to the field “Company Name.” Delete these words, then type in this name accordingly.      Next, provide the “Name,” “Street Address,” “City, State, Country” and the “ZIP Code” of the Ambulance Service Representative sending this letter. This should be the official contact information you with the Patient or Recipient of this invoice to use if contacting the Ambulance Service by mail.   In addition to this address, the “Phone” number and “E-Mail” address maintained by the Ambulance Service should be submitted. Produce these items on the next two available lines   

 

3 – Produce The Invoice And Patient Information

The invoice number the Ambulance Service’s bookkeeping or accounting department will use to keep track of payments for this paperwork (and the services listed) should be presented for the Patient’s (Or Client’s) use on the “Invoice #” line.   Continue to the right of the page then input the invoice “Date.”    Next, you will need to submit a production of the “Name” and billing address of the Invoice Recipient. This is the party responsible for payment. Enter this “Name” on the first available line following the bold words “Bill To.” The Invoice Recipient’s official billing address should then be supplied to the blank line “Street Address,” the “City, State, Country” below this, and the last line “ZIP Code.”   

 

4 – Summarize And Bill For The Service

You will also have to give an adequate (but concise) discussion of the service the Patient was given. This should be documented in the area underneath the “Description” heading making up the table on this page.    It is important that you plainly display the price for the ambulance service by inputting it to the field directly to the right of your “Description.” Notice the top of this column is titled “Amount” and is made up of a few boxes. The first two boxes will require the total amount due for the service provided without taxes included. You may list all charges in the first box under “Amount” then sum them up in the “Subtotal” box or you may produce the total without taxes due in both these boxes. Calculate then document the “Tax” that must be paid in the next box.
Add the “Subtotal” cost of the Ambulance Service to the “Tax” then submit the figure you arrive to in the “Total” box. The number of days that will be allowed to pass before a payment is considered late should be input to the blank line in the “Payment Is Due Within…” statement.    If you must present additional topics or content with this invoice, this can be done on the lines following the label “Comments Or Special Instructions.”    

 

How To Write In Excel

Download In Microsoft Excel (.xlsx)

1 – Obtain A Copy Of The Ambulance Service Invoice

When you are prepared to issue an invoice for ambulance service, select the “Excel” button (presented with the image) or the “Microsoft Excel (.xlsx) to gain access to this spreadsheet.

 

2 – Produce The Ambulance Service Contact Information

Once you have the sheet open, your first task is to display the banner or logo the Ambulance Service uses when it identifies itself on paperwork. This image should be placed in cell A1.  Report the full name of the Ambulance Service in cell A2.  Use cell A3 to identify the Ambulance Service Representative who can act as a Contact between the Service and the Patient (or Client).   The business address where the Ambulance Service expects its mail and payments to arrive should be documented for the convenience of the Invoice Recipient. Cell A4 will start the process of this presentation by requesting you produce the “Street Address” to its contents. You will need to continue inputting this address with its city, state, and country in cell A5 then finish reporting it by recording the current “ZIP Code” in cell A6.    Now, the Ambulance Service’s business “E-Mail” and “Phone” line must be placed in cell A7 and cell A8 respectively.   

 

3 – Address The Invoice Recipient

The Invoice Recipient may be an entity such as an Insurance Company or it may be the Patient being transported. In any case, you will need to specifically “Name” him or her in cell A11.          Furnish the address where the Invoice Recipient expects this bill to be sent to cells A12, A13, and A14.     

 

4 – Provide Definitions To The Invoice Tables

As we have mentioned, the beginning of this document must identify the Ambulance Service. In addition to this, it must also give the Patient or Invoice Recipient the information required to identify this document in the Ambulance Service accounting system or files. Thus, locate cell F4 and replace its contents with the invoice number. To the right of this, cell H4, the current “Date” has been placed to serve as the invoice “Date.” Leave this unaltered unless you wish to set this invoice as effective on a different calendar day.      The Ambulance Service should have the transportation and/or medical care provided to the Patient detailed. Handle this requirement by providing this report in cell A17.    Some additional cells have been placed on the right to help summarize the charges for the Invoice Recipient. First, enter the total cost of this transportation or care in cell H17. If there are no additional charges to consider then re-enter it in cell H18 as well.    The “Tax” portion of this table (cell H19) requires you to report the full amount of taxes the Patient or Invoice must pay.    Finally, submit the sum of “Subtotal” and “Tax” to cell H20.     Turn your attention to cell A21. Here, you can impose a limit on the amount of “…Days” the Patient or Invoice Recipient is allowed to pass without payment. Once this number of days expires, the account will be considered delinquent and subject to action. Enter this amount of days in place of the bracketed symbol in cell H21.  If additional paperwork or content must be given to the Patient or Invoice Recipient, then you may cite it by title or I.D. number in cell A22. You may also input such information directly to the contents of this sheet.   

Downloads: 2,021
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