28 Free Medical Receipt (Bill) Templates – Word, PDF

Medical receipts are documents that record details of the services that patients avail at healthcare facilities.

This information serves as proof of the encounter between the patient and the healthcare provider. A patient can benefit from it for reimbursing medical expenses or for financial record-keeping.

Medical receipt templates which healthcare providers usually use to save time and stay consistent, contain a few basic components. These templates are basically empty, pre-made forms of a medical receipt that healthcare professionals edit and fill out for each individual usage. The healthcare professionals fill out the medical receipt templates for the patients and provide them with copies of them. Doing so not only increases their patients’ comfort level, but also provides them with audit protection.

In this article, we cover all the parts that are essential to include on a medical receipt template for patients’ benefit. 

Free Templates

Medical receipts are important documents for patients availing medical services from any healthcare facility. Therefore, it is important that healthcare providers ensure that their receipts contain all the required elements to facilitate the patients. You can attain this surety by using a pre-made medical receipt template, which you can download for free from below. These forms are provided in different formats for your ease. 

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    The Importance of Medical Receipts 

    Medical receipts have significant benefits for all the parties involved in using them. Healthcare providers comply with HIPAA regulations regarding patient privacy. This protects the facility legally and ensures patient confidentiality. Patients who want to claim tax deductions for medical expenses also find these receipts very helpful in doing so. Moreover, they can also get reimbursements for the costs that they bear at your healthcare facility if they have health insurance by using the medical receipt as proof of payment

    The Key Components of a Medical Receipt Template 

    The medical receipt template must include all necessary components to facilitate patients in multiple ways. It must also be complete in areas that are useful for the healthcare facilities, such as those useful for tax audits. Therefore, it must be in complete detail. 

    A detailed and complete medical receipt template typically includes the following components:

    Healthcare provider/facility information 

    The first section of a medical receipt focuses on the information of the healthcare facility or provider. This can be a hospital, clinic, private practice, or home-based healthcare agency as well. This information will be based on their name, physical address, and contact information. The purpose of including these sections is identification and access to the healthcare provider in case it is required by the patient or a third party. Third parties, such as healthcare insurers might use this information to confirm claims. 

    Patient’s information 

    The detailed information of the patient who avails services of the healthcare provider or facility comes next on the receipt. Such as, the patient’s full legal name, residential address and contact details, including phone number(s) and email address will be required. Therefore, the medical receipt template should include sections based on these elements. 

    Date and time of service delivery 

    The specific date and time when the service was provided to the patient are very important on this receipt. Therefore, fields to mention these clearly must be included. In turn, this will serve as reference and proof of the services that the patient claims they took. 

    Descriptions of the services received 

    This is one of the most important sections on medical receipt templates as it lays out technical identifiers of the services received by the patient.

    It may include:

    • Itemized list: This is a detailed breakdown of the services the patient received. It includes information such as diagnoses, procedures and medicines given and treatments administered. 
    • CPT codes: Current Procedural Terminology or CPT codes are billing codes that represent each service are also part of a medical receipt. These protected health information (PHI) codes facilitate smooth reimbursement and claims processing significantly. Moreover, they are helpful in protecting the patients from unauthorized access to their medical records, which is a HIPAA compliance factor too. 
    • Quantity of units: Sometimes, the services that the healthcare provider provides may be included in units too.

    For instance: 

    Description Unit 
    Consultation 2
    X-ray 1

    Costs and charges

    This section of a medical receipt template will focus on the costs and charges of the services you provide. The patient may be provided with individual costs associated with each service, subtotals according to the category of services, and lastly, total costs. Individual costs will show the cost of each service, whereas the subtotal costs show the total costs of particular types or groups of services. Total cost is the summed-up value of all the costs. 

    Payment details 

    A medical receipt does not limit the payment details to the costs to be paid by the patient. They will also include the date the patient made the payment on, and the method of payment they used, such as credit card, cash or insurance coverage. 


    Sections for the healthcare provider’s signatures and/or the healthcare facility’s stamp must be part of the template. The latter (stamp) must contain contact information or other identifiers of the business. These elements mark the document as credible for third parties. 


    Include any disclaimers that might be necessary for the patients’ attention. For example, these could be based on refund policies, non-covered services, or more. 

    Tax identification number

    Although this part of the medical receipt template is optional, it can still be beneficial. Include a section to specify your healthcare facility’s Employee Identification Number (EIN), which is assigned to businesses by the IRS in The United States. Basically, IRS assigns EIN to healthcare facilities, including hospitals, clinics, and independent physicians.

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      A medical receipt is a document that is essential for legally compliant and professional provision of medical services to patients. Although the components healthcare providers include on it are not too technical, they are quite specific. The lack of any of these important components may lead to harmful situations for the patients and the facility. Therefore, it is important for these businesses to ensure that the medical receipt that they provide to their clients are structured well and contains complete information.

      About This Article

      Ryan Powell
      Authored by:
      Professional Business Management, Quality Assurance, Human Resources, Supplier Management
      With over 15 years in professional business management and an additional 4 years in e-commerce, Ryan Powell has distinguished himself as a strategic leader, steering sites to generate revenues exceeding $100 million. His approach emphasizes proactive problem-solving and profit optimization. Personal attributes such as strong organization, time management, and team collaboration bolster his professional portfolio. Ryan's experience spans leadership roles from Supervisor to General Manager, with notable contributions in Tier 1 Aerospace sectors, partnering with industry leaders like Boeing and Raytheon. He's adept at quality assurance, aligning with AS/ISO 9001 standards, lean methodology, financial management, including P&L oversight, and human resource strategies that prioritize employee retention. Ryan's comprehensive skill set positions him as an invaluable asset to growth-focused organizations.

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