Free Medical Charge Sheet Template
Medical Charge Sheet
[YOUR COMPANY NAME] | [YOUR COMPANY ADDRESS]
|
Invoice Details |
Bill To |
|---|---|
|
Invoice Number: 12345 |
Name: Malcolm Raynor |
|
Date of Issue: 2057-10-15 |
Billing Address: Jacksonville, FL 32099 |
|
Due Date: 2057-11-15 |
Contact Information: 222 555 7777 |
|
Description |
Quantity |
Unit Price |
Total |
|---|---|---|---|
|
Consultation Fee |
1 |
$100.00 |
$100.00 |
|
Laboratory Tests |
3 |
$50.00 |
$150.00 |
|
Subtotal: |
$250.00 |
|
Tax (10%): |
$25.00 |
|
Total Amount: |
$275.00 |
