Payment Receipt
Receipt Number: {{ payment_details.receipt_number }}
{{ hospital_info.name }}
{% if hospital_info.address %}{{ hospital_info.address }}
{% endif %}
{% if hospital_info.phone %}
{{ hospital_info.phone }}
{% endif %}
{% if hospital_info.email %}
{{ hospital_info.email }}
{% endif %}
{% if hospital_info.website %}
{{ hospital_info.website }}
{% endif %}
PAYMENT RECEIPT
Receipt Information
| Receipt Number: | {{ payment_details.receipt_number }} |
| Payment Date: | {{ payment_details.payment_date|date:"M d, Y" }} |
| Print Date: | {{ print_date|date:"M d, Y" }} |
| Processed By: | {{ payment_details.processed_by.get_full_name }} |
Patient Information
| Patient Name: | {{ payment_details.patient.get_full_name }} |
| Patient MRN: | {{ payment_details.patient.mrn }} |
| Phone: | {{ payment_details.patient.phone }} |
| Email: | {{ payment_details.patient.email }} |
Bill Information
| Bill Number: | {{ payment_details.bill.bill_number }} |
| Bill Date: | {{ payment_details.bill.bill_date|date:"M d, Y" }} |
| Due Date: | {{ payment_details.bill.due_date|date:"M d, Y"|default:"N/A" }} |
| Total Bill Amount: | ê{{ payment_details.bill.total_amount|floatformat:'2g' }} |
| Previous Payments: | ê{{ payment_details.bill.paid_amount|add:payment_details.amount_paid|floatformat:'2g' }} |
| Remaining Balance: | ê{{ payment_details.balance_after_payment|floatformat:'2g' }} |
Payment Details
| Payment Method: | {{ payment_details.payment_method }} |
| Reference Number: | {{ payment_details.reference_number }} |
| Notes: | {{ payment_details.notes }} |
Amount Paid
ê{{ payment_details.amount_paid|floatformat:'2g' }}
Payment Received Successfully
Thank you for your payment. This receipt serves as proof of payment.