Printable hospital template
Hospital payment allocation instruction sheet
Specify how one confirmed payment should be applied across invoices, check the allocation total and record who approved any unallocated balance.
- Written by
- RizCare
- Published
- Last reviewed
RizCare's suggested worksheet. Adapt to your hospital. https://riz.care/library/templates/clinic-payment-allocation-instructions
For billing staff handling a payment covering several invoices.
One transfer arrives for two invoices. The total may be clear while the intended split is not. Ask the authorised payer or account contact which bills the payment covers before staff begin allocating it.
This sheet captures instructions for a confirmed receipt. It does not confirm that money reached the hospital, or give one person's payment permission to settle another person's bill.
Print this page or save it as a PDF from your browser. The print layout contains only the blank worksheet and its completion note. Fill it in within your hospital.
Practice: ____________________ Prepared by: ____________________ Date: ______________
| Payment / instruction | Invoice | Balance before (naira) | Apply (naira) | Entry / balance after |
|---|---|---|---|---|
| Blank entry | ||||
| Blank entry | ||||
| Blank entry | ||||
| Blank entry | ||||
| Blank entry |
Keep completed copies with the staff authorised to use them.
How to use it
Establish the payment and the instruction
Use the hospital's authorised bank or cash confirmation and identify the existing payment record. Check that the person giving instructions may do so for the invoices concerned. Record the date and the communication reference. Keep patient names and private contact details in the protected records that these references retrieve.
Check each proposed allocation
List each invoice and its outstanding amount before this payment. Enter the amount to apply, then add the proposed allocations. Their total must not exceed the confirmed payment. If an allocation exceeds the relevant outstanding bill, stop and ask the authorised billing lead how the excess should be handled under the hospital's policy.
Reconcile the completed work
After the authorised entries are made, check their references and the resulting invoice balances. One 20,000-naira receipt split into 12,000 and 8,000 naira remains one received payment. If only 17,000 naira has clear instructions, keep the remaining 3,000 separately identified while clarification is sought. Do not allocate a leftover amount to a convenient unrelated invoice.
What each field means
- Payment reference
- Point to the original confirmed receipt. Repeating its reference on two allocation rows must not result in recording two incoming transfers.
- Instruction authority
- Record who instructed the split and where staff can retrieve that instruction. The worksheet should not become a public list of family relationships.
- Posting and remainder
- Distinguish proposed amounts from completed allocations. Record the total posted and any amount awaiting a decision so the incoming shift can continue without guessing.
Completed fictional example
Fictional allocations total 20,000 naira, with 2,000 naira still due on INV-072. The worksheet is an instruction record, not a RizCare feature claim.
| Payment / instruction | Invoice | Balance before (naira) | Apply (naira) | Entry / balance after |
|---|---|---|---|---|
| PAY-014 / AUTH-03 | INV-071 | 12,000 | 12,000 | AL-01 / 0 |
| PAY-014 / AUTH-03 | INV-072 | 10,000 | 8,000 | AL-02 / 2,000 |
Related resources
Sources and review
The worksheet design and examples are RizCare's recommendations. The sources below support the background discussion; they do not endorse this form.
- Bookkeeping and financial management training manual (FAO-hosted Liberia forestry training resource). Read 9 September 2026.