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Mobile Phlebotomist DIY Invoice Form for Payment

Updated on December 31, 2016
Brinafr3sh profile image

She is a Writer and Author. She's inspired by Eric Thomas, Les Brown, Charles Stanley, Myles Munroe, and Napoleon Hill.

Mobile Phlebotomy Invoice
Mobile Phlebotomy Invoice

Independent Contractor Invoice (sample)

  • To: (Payer) Barbara McKee - Case Manager
  • Address: __________________
  • Phone Number: ___________
  • Fax Number: ______________
  • EIN or Social Security Number: _______________

  • From: (Payee) Janet Brazille - CPT/Insurance Examiner
  • Address: ___________________
  • Phone Number: ______________
  • Fax Number: _____________
  • EIN or Social Security Number: _______________

Exam Date
Patient Name
Bar Code #
Fee Charged
Sanchez, Benjamin
Reimbursement for Mileage
Johnson, Lilly
Lab One
Reimbursement for Lab kit
Gonzales, Sandra
Heritage Lab
Reimbursement for Mileage
Gonzales, Michael
Heritage Lab
Completed husband and wife exam
TOTAL $ 160.00
Payer's Signature _________Date
Payee's Signature ________Date
Sample Paramedical Examiner Invoice

How to Write an Invoice for Paramedical Exams

Phlebotomist that work for paramedical exam companies are titled as: Mobile Phlebotomist, Insurance Examiners, and Paramedical Examiners. As Certified Phlebotomist we have to keep records of our own payments that are received by Paramedical Exam companies. Some paramedical exam companies will not pay you unless you send them an independent contractor's invoice.

The invoice format above is a good example of how to write a Mobile Phlebotomy Invoice.

  1. Start with the header for your invoice; you can center your heading.
  2. Write the information of the person you're doing the work for (paramedical exam company), full name and their title.
  3. Write the Mobile Phlebotomist/CPT (you) information, and include your title behind your full name.
  4. Fill in: the date of each exam, patient/insurance applicant name, procedure performed, laboratory name, bar code # on the lab kit label, flat rate fee you charged to the paramedical exam company, notes of things you want to remember or include to the invoice.
  5. Then add up your total once you're finish completing all the exams for that particular paypay period.
  6. Include your signature and the current date; if you're faxing the invoice you can also get the signature of the paramedical exam company's case manager.

Many Mobile Phlebotomist set their own "flat rate fees" for the insurance exams, since they are not working by the hour or by salary. It's a great idea to type up a "cost sheet" as well, for the type of insurance exams you're doing such as; paramed form/blood/urine, paramed form, or just urine.

To make your invoice look professional you can use Microsoft Word, Word Pad, Note Pad, Excel, etc. Once the pay period for all exams you complete is done, you can begin sending your invoice by faxing, mail, E-mail, or in person.

Some paramedical exam companies pay their workers according to pay periods, for example the 1st of the month through the 16th of the month can be a pay period, and then they will pay you after the 16th. Some paramedical exam companies pay as soon as the work is completed.


Independent Contractor - a worker who provides services to a company but is not an employee or agent of that company.

© 2012 Brinafr3sh


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