A 6-page invoice template (5 form pages plus 1 instructions page) for one billing period of non-medical home care, from the bill itself through the visit log, payment terms and remittance, and a monthly account summary.

For a small USA home care agency billing a client or a family payer. You get one editable Word file, plus 1 agency instructions page to remove before use.

What’s included

1. Invoice: invoice number, dates and service period, payment terms and due date, who is billed and who was served, service charges, additional charges, totals, balance due, and how to pay
2. Visit and service detail log, with time in and out, hours, caregiver, service type, rate and line amount, plus an optional mileage log
3. Payment terms and remittance: a remittance slip to return with payment, and a payment receipt the agency completes when payment posts
4. Monthly account summary: invoices, payments, credits and balances, balances and aging (current, 1-30, 31-60 and 61+ days past due), and a running payment tracker
5. Agency instructions page, to remove before use

Add your logo and name

1. Open the Word file. On the first page, replace the Agency Logo box with your logo.
2. Replace Agency Name with your agency name.
3. Replace the address line, and the phone, email, and website line, with yours.
4. Delete the instructions page and save the Word file to use when you bill.

Editable template for your agency to adapt. Not legal advice, not a license to operate, and not HIPAA software. Match the terms to your state rules and your own billing policy before the first invoice goes out.