Medical Bill Template

June 23, 2011

A Medical bill template is a document which represents a medical invoice provided by any hospitals, medical stores, pharmaceutical sales or health care units. This document contains all the necessary information about a patient’s medical expenditure.

Sample Medical Bill Template

Name of the patient: ____________________________ Age: ______

Address: __________________________ [Mention the patient’s address]

Consultant: ______________________ [Name of the doctor diagnosing]

Invoice no: ________________

Mode of payment: ________________ [Patient have to mention the mode of payment for e.g. cash, cheque, credit card etc]

Admission date: _____________________ [in case of bill payment at hospital patient have to mention the date of their admission in the hospital]

Discharge Date: _____________________ [patient’s release date from hospital]

Particulars                                          Amount

_____________                                ___________

_____________                                ___________

_____________                                ___________

_____________                                ___________

_____________                                ___________

_____________                                ___________

Total Cost (including all taxes): _____________________

Mediclaim (if any) __________________ [Discount offered in medical bill due to any medical policies]

___________________                                                        _________________________

Signature of the cashier                                                           Signature of the patient party

Download Medical Bill Template in Word Format

Leave a Comment

Previous post:

Next post: