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Invoice Gh00094427

This invoice is for outpatient medical services provided to Mr. Khojiakbar Karimberdiev on October 30, 2022 at GMA Medical Treatment Facilitation Services LLC. The services included an initial specialist consultation, a pelvis x-ray, and an x-ray of the knee. The total amount due for the services is 1,515 AED.

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Ahmed Gomaa
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579 views1 page

Invoice Gh00094427

This invoice is for outpatient medical services provided to Mr. Khojiakbar Karimberdiev on October 30, 2022 at GMA Medical Treatment Facilitation Services LLC. The services included an initial specialist consultation, a pelvis x-ray, and an x-ray of the knee. The total amount due for the services is 1,515 AED.

Uploaded by

Ahmed Gomaa
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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TAX OUTPATIENT INVOICE (Credit-GMA MEDICAL TREATMENT FACILITATION SERVICES LLC)

Patient No. : GH00094427 Invoice No : 218727


Name : Mr Khojiakbar Karimberdiev Invoice Type : Credit
Age/Sex : 23Y/M DOB :23/07/1999 Invoice Date : 30/10/2022
Address : ,Abu Dhabi Visit Date : 30/10/2022
Tax Reg. No. : Doctor : M. TAREK MOUALEM
     Department : ORTHOPAEDICS
: GMA MEDICAL TREATMENT FACILITATION SERVICES :
Insurance Policy No
LLC
: GMA MEDICAL TREATMENT FACILITATION SERVICES Member ID/Card :
Policy Name 123
LLC #
Customer Reg. :
No
Insurance
Approval Code :
Net Tax Patient
Description Unit Gross Discount Discount% Tax% Credit
Amount Amount Pay
CONSULTATION
7041 Consultation Specialist Initial 1 690.00 0.00 0.00 690.00 0.00 0.00 0.00 690.00
(10)
RADIOLOGY
8527 Radiologic Examination, 1 437.00 0.00 0.00 437.00 0.00 0.00 0.00 437.00
Pelvis; Complete, Minimum
Of 3 Views
(72190)
8644 X-Ray Exam Of Knee 3 1 388.00 0.00 0.00 388.00 0.00 0.00 0.00 388.00
(73562)

Gross Amount : 1,515.00


Net Amount : 1,515.00
Amount to be Claimed : 1,515.00

Claimed Amount : DIRHAMS One Thousand Five Hundred and Fifteen

Prepared By : 7000268 Counter Name : Opd Counter Cashier


Printed Date : 03/11/2022 16:03:21

* Non insured items

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