Patient Invoice
Patient Invoice
Patient Invoice
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Patient Invoice
Invoice
795 Folsom Ave, Suite 600
San Francisco, CA 94107
P: (123) 456-7890
San Francisco, CA 94107
P: (123) 456-7890
Order # 12345
21st October 2018
21st October 2018
Billed To:
John Smith
1234 Main StreetApt. 34/4B
Springfield
ST 54321
Payment Method:
Credit Card
Visa ending **** 4242jsmith@email.com
Total Due:
$ 2140.00
Order summary
Item |
Price |
Quantity |
Totals |
| Consultation | $10.99 | 1 | $10.99 |
| Medicine BS-400 | $20.00 | 3 | $60.00 |
| Lab Report | $600.00 | 1 | $600.00 |
| Rx | $1000.00 | 1 | $1000.00 |
Subtotal |
$1670.99 |
||
Shipping |
$15 |
||
VAT |
$150.23 |
||
Total |
$1985.99 |