	[Hospital Name] [HospitalAddress]

OUTPATIENT INVOICE ([Paymenttype])

[InsuranceDetails]

Patient ID	[PatientNo]			Invoice No	[InvoiceNo]
Name	[PatientName]			Invoice Type	[InvoiceType]
Age/Gender	[Age/Sex]			Invoice Date	[InvoiceDate]
Address	[Address]			Visit Date	[VisitDate]
[HocTin]	[HocTinValue]			Doctor	[Doctor]
National ID	[NationalID]

[InvoiceDetails]

Gross Amount

[GrossAmt]

Discount

[Discount]

Refund

[Refund]

Round Off

[RoundOff]

Net Amount

[NetAmt]

Deduct Amount

[DeductAmt]

Co-Payment Amount

[CopaymentAmt]

Noninsured Amount

[NoninsuredAmt]

Tax Amount

[Taxtotal]

Cess Amount

[Cesstotal]

Less Advance

[LessAdv]

Patient Payable

[PatientPayable]

Amount to be Claimed

[AmtClaimed]

Patient Payable : [PatientPaywords]

Claimed Amount : [ClaimedAmtWords]

Prepared By : [Username]	Counter Name : [Counter]	Cashier
Print Date : [InvioceDatetime]	Remarks : [Remarks]