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