Medical Assessment Services
Email: info@veramedical.com | Phone: (555) 123-4567
123 Medical Plaza, Suite 400, Toronto, ON M5H 2N2
{{ invoice['invoice_number'] }}
{% if invoice['status'] == 'paid' %} PAID {% elif invoice['status'] == 'sent' %} SENT {% elif invoice['status'] == 'overdue' %} OVERDUE {% elif invoice['status'] == 'draft' %} DRAFT {% endif %}{{ invoice['client_company_name'] }}
{% if invoice['client_alias'] %}{{ invoice['client_alias'] }}
{% endif %} {% if invoice['client_billing_address'] %}{{ invoice['client_billing_address'] }}
{% endif %} {% if invoice['client_postal_code'] %}{{ invoice['client_postal_code'] }}
{% endif %} {% if invoice['client_phone'] %}Phone: {{ invoice['client_phone'] }}
{% endif %} {% else %}No client information available
{% endif %}Invoice Date: {{ invoice['invoice_date'] }}
{% if invoice['service_date'] %}Service Date: {{ invoice['service_date'] }}
{% endif %} {% if invoice['case_id'] %}Case Number: {{ invoice['file_case_id'] }}
{% endif %} {% if invoice['claimant_full_name'] %}Claimant: {{ invoice['claimant_full_name'] }}
{% endif %}| Service Code | Description | Date | Amount |
|---|---|---|---|
| {{ invoice['service_code'] or 'N/A' }} | {{ invoice['service_description'] or 'Professional services rendered' }} | {{ invoice['service_date'] or invoice['invoice_date'] }} | ${{ "%.2f"|format(invoice['fee']) }} CAD |
| Subtotal: | ${{ "%.2f"|format(invoice['fee']) }} CAD |
| Tax ({{ "%.0f"|format(invoice['tax_rate']) }}%): | ${{ "%.2f"|format(invoice['tax_amount']) }} CAD |
| TOTAL: | ${{ "%.2f"|format(invoice['total_amount']) }} CAD |
Provider: {{ invoice['specialist_name'] }}
{% if invoice['specialist_specialty'] %}Specialty: {{ invoice['specialist_specialty'] }}
{% endif %}{{ invoice['notes'] }}