Medical Receipt Template

July 2, 2011

A Medical receipt template is prepared by hospitals or physicians to provide an invoice of their services to the client. The template works as a basic draft to design medical receipt. This template shows medical services hired by client and their bill as well.

Sample Medical Receipt Template

Name of hospital/Physician_____________
Address__________ Phone__________ Email__________
(This part shows name and contact details of hospital/doctor.)
Receipt serial number__________ Receipt date___/___/___
(General information about receipt should be filled here.)
Patient name__________ Age_____ Sex____
Mailing address_________ Phone___________ Email_____
(This part contains general information about the patient.)
Stay in hospital______________ Charges____________
Medical treatment description: Tests__________ Charges____________
Drugs and medical prescription___________ Net charges_________
Any surgery/operations____________ Cost_________________
(This is an important section to describe client illness and its treatment details.)
Grand total______________
A sum of____________ received by____________ (Client name/signature).
Payment mode: Cash/Card___________
In case of card: card number___________
(This part shows the details of payment mode and final paid amount).
Signature of doctor__________ dated___/___/___

Download Medical Receipt Template in Word Format

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