Mobile Phlebotomy Invoice Template
A mobile phlebotomy invoice should state the collection date and location, the number of patients drawn, the base draw fee and any additional-patient rate, the travel zone fee, and any STAT or after-hours premium — with your certification number shown. Patient invoices are receipts paid on the spot; lab and agency invoices reference a contract or PO and bill per collection or monthly. ShowTheReceipts handles both from the same saved line items.
Header block
- Business name, phlebotomy certification number, phone
- Patient or account name
- Collection date, time, and service location
- Invoice number, terms or payment method
Patient visit lines
- Base draw fee — per patient
- Additional patient, same address — reduced rate
- Travel fee — by zone
- Specialty draw — pediatric, geriatric, difficult access
- Specimen processing / centrifuge
- Lab drop-off
- STAT, after-hours, or weekend premium
- No-show / not-home fee
Lab or agency account block
| Line | Basis |
|---|---|
| Collections | Count × contracted rate |
| Stops | Count × stop or zone fee |
| STAT collections | Count × premium |
| Period | Date range, contract or PO reference |
| Terms | Net 15 / net 30 |
Keep clinical detail off the invoice entirely. Dates, counts, locations, and charges — that’s the whole document.
What not to do
- Don’t put test names, results, or diagnostic information on a billing document
- Don’t omit your certification number — it’s what makes the receipt reimbursable
- Don’t invoice a lab account the way you invoice a patient
- Don’t absorb the drive on your furthest appointments
Frequently asked questions
What identifying information should be on it?
Your business name and certification, the collection date and time, the service location, and a patient or account reference — never clinical results or diagnostic detail. The invoice is a billing document, not a medical record, and should be written that way.
How does a lab account invoice differ from a patient one?
It's a summary: stop count, draw count, dates, zone fees, and any STAT charges, referencing the contract or PO, on net terms. Patient invoices are single-visit receipts paid at the door.
Should travel be a line item?
Yes, by zone. It makes your pricing legible to the patient and it prevents you from quietly absorbing the cost of the furthest appointments in your day.
Can this invoice be used for HSA or FSA reimbursement?
Commonly, yes — provided it shows your business name, credential, service date, description of service, amount paid, and payment method. Missing the credential is the usual reason a submission comes back.