A Free Hospital Receipt Templates Sample

Hospital receipt templates can be defined as documents that show the bills for the hospital services to the patients. Different hospitals may have different formats for their receipts. However, basically they include the same information on the receipt. So, it is important to know what to include there.

Sample Hospital Billing FAQs Templates

How to Write Hospital Receipt Templates

There are many hospital receipt template samples you can find on internet and this is one of them. We will give you a sample with the detailed information included on the template. You can start with the name and logo of the hospital at the topmost.

Under the name & logo of the hospital, you need to include some important elements of information. One of them is the hospital’s address. Besides that, you also need to write the name of the patient. Other information includes account number, responsible party, and insurance.

On this receipt, you have to emphasize that it is a bill. So, you can write “Doctor Bill” or “Hospital Bill” with bolded and capitalized letters. Then, it can be followed with the name of the receiver. Do not forget to include the receiver’s address completely so that it will be received by the right person.

Now, you can start providing the details of billing. It is better if you serve it in a table with some headers based on the needed information. From the leftmost column, it can be headed with Service Date. If the services includes more than one day, you can list it down based on each type of services.

The next heading on the table provided on this hospital invoice template is Type of Service. On this column, all the services provided by the hospital must be included such as new visit, X-ray knee 2 views, knee immobilizer, drugs for patients, etc.

Next, it is important to add other important information. For example, you can include Date, Billed Charged, Amount Paid by Plan, Adjustments, Patient Payment and Due from Patient. After you include all the information above, you should provide Subtotal and Totals of amount to be paid.

That is the top portion of the hospital receipt. In this sample, the hospital receipt has 2 portions. The bottom portion should be returned with the patient’s payment. On the bottom portion, what you need to include can be started with Due Date. It is the maximum date the patients must pay the bill.

Besides that, you also need to include Account Number. Then, you should provide the options of credit card payments and let the patients to choose one. Some of the details of information also need to be included such as print name on card, card number, and also expiration date.

Lastly, this hospital invoice must dedicate a space for signature. It is also needed to include the address of the hospital. One more, it is important to say thank to the patients. For example, you can write “Thank you for your visit” at the bottom of the hospital receipt templates.

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