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Policy Name: Membership No.: Particulars: Bupa 408651001 Slfe 17707077

This medical bill is for Mr. Saber El Sayed El Kassas, an Egyptian national, for a surgical tooth extraction. The procedure code was 226/48 and the gross amount was EGP 1,100. There was a EGP 50 deductible amount. With a 5% VAT of EGP 55 added, the total amount including VAT was EGP 1,155. The patient net amount was EGP 52.50 and the insurance company's net amount was EGP 1,102.50 after deducting the patient's payment and VAT.

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Saber Elkassas
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63 views

Policy Name: Membership No.: Particulars: Bupa 408651001 Slfe 17707077

This medical bill is for Mr. Saber El Sayed El Kassas, an Egyptian national, for a surgical tooth extraction. The procedure code was 226/48 and the gross amount was EGP 1,100. There was a EGP 50 deductible amount. With a 5% VAT of EGP 55 added, the total amount including VAT was EGP 1,155. The patient net amount was EGP 52.50 and the insurance company's net amount was EGP 1,102.50 after deducting the patient's payment and VAT.

Uploaded by

Saber Elkassas
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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VAT Registration No 310252763300003 ‫ﺭﻗﻢ ﺗﺴﺠﻴﻞ ﺿﺮﻳﺒﺔ ﺍﻟﻘﻴﻤﺔ ﺍﻟﻤﻀﺎﻓﺔ‬

MRN : KHB4000024979 : ‫ﺭﻗﻢ ﺍﻟﺴﺠﻞ ﺍﻟﻄﺒﻲ‬ Bill No: INV-O-KHB4-20009270 : ‫ﺭﻗﻢ ﺍﻟﻔﺎﺗﻮﺭﺓ‬

Patient Name: Mr Saber El Sayed El :‫ﺳﻢ ﺍﻟﻤﺮﻳﺾ‬ Bill Date: Jun 20, 2020 3:29 PM : ‫ﺗﺎﺭﻳﺦ ﺍﻟﻔﺎﺗﻮﺭﺓ‬
Kassas Consultanat : Dr Ali Al Moghazy : ‫ﺍﻟﻄﺒﻴﺐ ﺍﻟﻤﻌﺎﻟﺞ‬
Nationality: EGYPTIAN : ‫ﺟﻨﺴﻴﺔ‬ Bupa
Insurance Name :
Identification No: 2468495037 :‫ ﺍﻻﻗﺎﻣﺔ‬/ ‫ﺭﻗﻢ ﺍﻟﻬﻮﻳﺔ‬ 408651001
Policy No :
Visit No: OP-008 : ‫ﻋﺪﺩ ﺍﻟﺰﻳﺎﺭﺍﺕ‬ Policy Name : SLFE
Age/Sex: 28Yrs/MALE : ‫ ﺍﻟﺠﻨﺲ‬/ ‫ﺍﻟﻌﻤﺮ‬ Membership No.: 17707077

Particulars CPT / Qty Gross Discount Sub Deduct. Net Amount Patient Company Deduct Net Amt
‫ﻭﺻﻒ ﺍﻟﺨﺪﻣﺎﺕ ﺍﻟﻄﺒﻴﺔ‬ Tooth No ‫ﺍﻟﻌﺪﺩ‬ Amt Amt Total Amount ‫ﺻﺎﻓﻰ ﺍﻟﻘﻴﻤﺔ‬ VAT Vat With With
/‫ﻛﻮﺩ ﺍﻟﺨﺪﻣﺔ‬ ‫ﺍﺟﻤﺎﻟﻰ ﺍﻟﻘﻴﻤﺔ‬ ‫ﺍﻟﺨﺼﻢ‬ ‫ﺍﻻﺟﻤﺎﻟﻰ ﺑﻌﺪ‬ ‫ﻗﻴﻤﺔ ﺍﻟﺘﺤﻤﻞ‬ ‫ﺿﺮﻳﺒﺔ ﺍﻟﻤﺮﺍﺟﻊ‬ ‫ﺿﺮﻳﺒﺔ ﺷﺮﻛﺔ‬ Patient VAT Company
‫ﺭﻗﻢ ﺍﻟﺴﻦ‬ ‫ﺍﻟﺨﺼﻢ‬ ‫ﺍﻟﺘﺎﻣﻴﻦ‬ ‫ﻗﻴﻤﺔ ﺍﻟﺘﺤﻤﻞ‬ VAT
‫ﺑﺎﻟﻀﺮﻳﺒﺔ‬ ‫ﺍﻟﺼﺎﻓﻰ ﺑﺎﻟﻀﺮﻳﺒﺔ‬

DENTAL

Surgical Extraction of 226/48 1 1100.00 0.00 1,100.00 50.00 1,050.00 2.50 52.50 52.50 1,102.50
partially or fully impacted tooth

Sub Total: 1,100.00 0.00 1,100.00 50.00 1,050.00 2.50 52.50 1,102.50

Add : VAT VAT Amount

VAT(Applicable on Amount 1100) 55.00


‫ﺍﺟﻤﺎﻟﻰ ﺍﻟﻘﻴﻤﺔ‬ Gross Total : 1,100.00
‫ ﺍﻟﺨﺼﻢ‬Discount : 0.00
:
‫ ﺿﺮﻳﺒﺔ ﺷﺮﻛﺔ ﺍﻟﺘﺎﻣﻴﻦ‬VAT( 5%) 55.00
‫ﺍﻻﺟﻤﺎﻟﻰ ﺑﻌﺪ ﺍﻟﺨﺼﻢ ﺑﺎﻟﻀﺮﻳﺒﺔ‬ Total Amount including VAT : 1,155.00
‫ ﺍﻟﺘﺤﻤﻞ ﺍﻟﻤﺪﻓﻮﻉ ﻧﻘﺪﺍ‬Patient Net Amount : 52.50
Patient Collected Amount : 52.50
Patient Balance Amount : 0.00
‫ﺍﻟﺼﺎﻓﻰ ﺑﺎﻟﻀﺮﻳﺒﺔ‬ Insurance Net Amount : 1,102.50

{ENSGN#80,20#Patient#001}
Received by ‫ﺍﻟﻤﺴﺘﻠﻢ‬ Prepared by : Amal Al Dosary

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