Medical Receipt Template

The issuing party generally sends this to the patient following the patient’s payment of a medical bill invoice. Patients need to save medical receipts for their tax returns and insurance reimbursements, if applicable.

What to Include

• Description of each service performed;
• Medical institution’s information (name, address, phone, email);
• Medical practitioner’s name, address, phone number, and license number;
• Name, description, and dosage of each medication administered;
• Patient’s information (name, address, phone, email);
• Payment method (cash, check, credit card, other);
• Receipt number;
• Signatures of both parties;
• Summary of charges:
  • Billing codes;
  • Cost of each service performed and medication administered,
  • Cost of add-ons (if applicable),
  • Quantities of items and add-ons,
  • Subtotal,
  • Tax rate,
  • Total taxes due,
  • Total amount due,
  • Amount paid, and
  • Outstanding balance (if applicable); and
• Transaction date.