SILVER INVOICE SAMPLE
Veterinary Clinic Invoice
Silver Plan
Clinic Name: Happy Paws Veterinary Clinic
Patient Name: Luna
Patient ID: 654321
Rabies Tag Number: RBT-11223
| Service | Total Cost | Covered by Plan | Amount Patient Pays |
|---|---|---|---|
| General Visit | $30.00 | $18.00 (60%) | $12.00 |
| Vaccinations | $100.00 | $100.00 (100%) | $0.00 |
| Hospitalization | $150.00 | $60.00 (40%) | $90.00 |
| Total | $178.00 | $102.00 | |