Hospital Bill Invoice Template

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Hospital Bill Invoice Template is a versatile document that will inform Clients of a due payment. The document available through the links below can be employed to display specifics defining a hospital stay, treatment, medications, or any other charges that must be paid for. Naturally, if any additional documentation should be included there will be an area where this can be done. It is recommended that you utilize every area of this invoice since these sections were developed to deliver the minimum content most Patients and Clients will expect.

How to Write in PDF and MS Word

Download: Adobe PDF & Microsoft Word (.docx)

1 – Save The Hospice Invoice Displayed On This Site

You should download the paperwork featured in the preview image on this page. Two areas will contain a method of access to the file you desire. You may either use the text links below the title of this section (“Adobe PDF,” “Microsoft Word (.docx)” or the buttons underneath the pictured document

 

2 – Identify The Hospital

Record the legal name of the Hospital in the “Company Name” field.        Naturally, an individual who works for and is authorized by the Hospital issuing an invoice to handle any Patient Client questions regarding treatment or this bill. Report the Hospital Representative’s “Name” on the first empty line.      The next empty lines that require material will be labeled with address components. The mailing address for the Hospital’s Accounts Payable or Bookkeeping Department should be produced as the “Street Address,” “City, State, Country,” and “Zip Code.”      In addition to the Hospital Representative’s address, fill in the “Phone” and “E-Mail” information the Patient Client may use to contact the Hospital Representative dealing with this paperwork.     

 

3 – Record The Hospital Invoice And Patient Information

The paperwork making up this invoice should be defined by a unique item. Oftentimes, this will be referred to as an “Invoice #” and composed of numbers, letters, or both. This is the call number a Hospital Employee would use to find this document in its filing system.      Another empty line has been placed across the page (on the right). Produce the Hospital’s invoice “Date” for these charges on this line    After satisfying the invoice section, we will need to make sure the “Patient Information” section is satisfied with the content it requires. This area will only require some basic information to identify the Patient in the Hospital’s records and will begin with the blank line labeled “Name” underneath the heading “Patient Information.” This must be the “Name” of the individual who received medical care at the Hospital.      Next, record the “Age” (in years) and “Gender” of the Patient on the next two blank spaces.   Now, you must report where the Patient is (or was) in the Hospital. Record the Department (i.e. ICU, Oncology, ER, etc.) responsible for the Patient’s care on the blank space labeled “Hospital” then record the bed number reserved for the Patient on the “Bed No” line.    The first calendar date of the Patient’s care should be recorded on the “Admission Date” line while the last calendar date of the Patient’s care must be furnished to the blank space labeled “Discharge Date.”             

 

4 – Officially Invoice The Entity Paying For The Patient’s Care

In many cases, the Payer and the Patient will be two different entities, therefore a separate section has been included strictly to name the party responsible for paying this invoice. Turn your attention to the right-hand column in this area then produce the “Name” on the first available line                             Produce the Paying Entity’s address on the next three blank spaces.                  Finally, document an additional means of contact that can be used to reach the Payer using the “Phone/E-Mail” line.      The “Medical Procedure” table in the middle of the page will give a definitive area where you can summarize details for the care given. Generally, this will be in the form of date(s) and time(s), medication(s), and/or treatment(s) provided to the Patient.     The “Amount” column is devoted to discussing what the Paying Entity must submit to uphold his or her responsibility. Report the basic cost of the medical procedures the Hospital provided in the first box under “Amount” then add each of these amounts (if more than one is reported) as a sum in the “Subtotal” box.                     If the Hospital must add taxes to this invoice, then input this “Tax” in the next available box.              The “Tax” and “Subtotal” should be recorded as one summed amount of money in the “Total” box at the bottom of this column.    Your attention will also be required in the sentence starting with the phrase “Payment Is Due…” where the number of “…Days” that the Hospital expects a payment sent must be supplied on the displayed empty line.            The “Comments Or Special Instructions” part of this invoice may be used as a staging area for additional material.       

 

How to Write in MS Excel

Download: Microsoft Excel (.xlsx)

1 – Save The Spreadsheet Version Of The Hospital Bill

The “Excel” button and similarly designated text link above should be selected to access this bill as a spreadsheet invoice. Save this to a convenient folder in your system.

 

2 – Present The Name And Contact Details Of The Hospital

Produce the Hospital’s banner/logo in cell A1 then its complete “Company Name” in the next cell down (A2).          Cell A3 contains the text label “Name” and is concerned with Hospital Representative responsible for coordinating with the Client to obtain payment for its services. Record the complete “Name” of this Employee or Representative accordingly.           Now that we have identified the Hospital as the Sender and the Hospital Representative as an individual who can act as a Contact Person for the Patient/Client, we must document some viable means of communication. The first will be the Hospital’s mailing address which should be displayed using the three cells A4, A5, and A6.
Present the Hospital’s “E-mail” address in cell A7 then document the Hospital’s telephone number in cell A8. Keep in mind that if an extension needs to be entered to reach the person in cell A3 using this number, it must be reported as well.         

 

3 – Identify This Hospital Bill, The Patient, and The Payer

Notice that three distinctive sets of cells have been placed throughout this sheet above the table in the center. The top right area presents two cells where some important information can be dispensed to the Patient and Client. The invoice number used to keep track of the payment status for these charges should be presented for the Patient and the Client’s bookkeeping use as well thus, enter it cell F4. If the current “Date” is appropriate for this invoice you may leave it as it appears in cell H4. If not, then you can adjust it.                  The next two tables (“Patient Information” and “Bill To”) also need your attention. Both are intended to facilitate the payment of this invoice so begin filling out the one in column A with the Patient’s full “Name,” current “Age,” and his or her “Gender” to cells A11, A12, and A13 respectively.      Now, record the Hospital Department or Wing and the bed number where the Patient received care to cells A14 and A15.      The first calendar day of the Patient’s stay at the Hospital is considered the “Admission Date” and should be entered in cell A16 while the calendar day when the Patient terminates his or her stay at the Hospital must be recorded in cell A17.      Column E, on the right, has been placed so that we can name a specific entity as the Client who’s agreed to pay the Hospital for the Patient’s stay or care. Several articles of information are required in this portion of column E beginning with the “Name” of the billed entity (i.e. an insurance company).      Cell E12 (“Street Address”), E13 (“City, State, Country”), and E14 (“ZIP Code”) have been included as a display area for the Client Address where this invoice is being sent. Satisfy these cells in column E with the requested information.        The Client’s telephone number or email address are also requirements here. Ideally, you should report both however one is satisfactory so long as it is a reliable way of reaching the Client directly.           

 

4 – Record The Specifics Of The Hospital Care Provided

The table in the middle of the invoice will need information describing the medical care received by the Patient recorded in cell A20 (“Medical Procedure”). Use this area to present the specifics of the medical care or the length of stay the Hospital provided to the Patient in this cell.      Column H, containing several requests for material, begins with the “Amount” field. Document the dollar “Amount” owed in this cell (H20) then sum up all the costs to one total and enter this in cell H21 (“Subtotal”).           Now, enter the “Tax” due for these charges in cell H21. This figure and that in cell H21 (“Subtotal”) must be added to one “Total” and entered in cell H23 as the amount due for this invoice.         Cell A24 delivers a sentence to this paperwork that is meant to obligate the Client to pay the Hospital Bill within a given time period or risk being considered delinquent. This time period must be displayed as a number of days in this cell in place of the brackets        Cell A25 is available for your use should more material need to be included. Input it directly after the words “…Special Instructions” if this is necessary.           

 

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