Purchase Order Doctor General Practitioner in Belgium Brussels –Free Word Template Download with AI
Medical Services Procurement — Doctor General Practitioner — Belgium Brussels
Issued in accordance with the Belgian Federal Public Procurement Code and the Brussels-Capital Region Healthcare Regulations
1. Purchasing Entity (Buyer)| Organization: Hôpital Régional de Bruxelles — Primary Care Division | VAT Number (BE): BE 0456.789.123 |
| Address: Avenue Louise 250, 1050 Brussels, Belgium | Contact: [email protected] |
| Authorized Officer: Dr. Catherine Vermeulen, Head of Procurement | Phone: +32 2 555 0147 |
| Practitioner Name: Dr. Marc-Antoine Delacroix, MD | Professional License No.: BE-RIZIV-2019-44821 |
| Specialization: Doctor General Practitioner (Huisarts / Médecin Généraliste) | RIZIV / INAMI Registration: 9876543210 |
| Practice Address: Rue de la Loi 112, 1040 Brussels, Belgium | VAT Number (BE): BE 0712.345.678 |
| Chamber of Commerce (Brussels): 0891.234.567 | Contact: [email protected] |
This Purchase Order is issued to engage the services of the above-named Doctor General Practitioner for the provision of primary healthcare services, diagnostic consultations, and associated medical supplies within the Brussels-Capital Region of Belgium. The Doctor General Practitioner shall deliver all services in compliance with the Belgian Law of 22 August 2002 on the Practice of the Medical Professions and the regulations of the Brussels-Capital Region Health Authority.
| Ref. | Description of Service / Item | Quantity | Unit | Unit Price (EUR) | Total (EUR) |
|---|---|---|---|---|---|
| 01 | General medical consultation — Doctor General Practitioner (initial patient assessment, anamnesis, and treatment plan) | 120 | consultations | 65.00 | 7,800.00 |
| 02 | Follow-up consultation — Doctor General Practitioner (chronic disease management, medication review) | 80 | consultations | 50.00 | 4,000.00 |
| 03 | Preventive health screening package (blood work, ECG, cardiovascular risk assessment) administered by the Doctor General Practitioner | 40 | packages | 120.00 | 4,800.00 |
| 04 | Home visit service — Doctor General Practitioner (Brussels municipal districts 1000–1050) | 25 | visits | 95.00 | 2,375.00 |
| 05 | Medical certificate and administrative documentation (work incapacity, insurance forms, RIZIV referrals) | 60 | documents | 25.00 | 1,500.00 |
| 06 | Stethoscope, Littmann Classic III (procured for the Doctor General Practitioner's practice) | 2 | units | 185.00 | 370.00 |
| 07 | Electronic blood pressure monitor, validated for clinical use in Belgium | 3 | units | 145.00 | 435.00 |
| 08 | Annual professional liability insurance — Doctor General Practitioner (Brussels region coverage) | 1 | policy | 2,200.00 | 2,200.00 |
| 09 | Continuing medical education (CME) subscription — Belgian Society of General Practice (SGB / SBGM) | 1 | year | 350.00 | 350.00 |
| 10 | Electronic health record (EHR) software license — compliant with Belgian eHealth platform (MyCareNet) | 1 | license | 1,800.00 | 1,800.00 |
| Subtotal (excl. VAT): | 25,630.00 | ||||
| VAT (21% — Belgian standard rate): | 5,382.30 | ||||
| TOTAL AMOUNT DUE (EUR): | 31,012.30 | ||||
4.1 This Purchase Order constitutes a binding agreement between the Purchasing Entity and the Doctor General Practitioner for the provision of the services and supply of the items listed herein. All services shall be rendered within the administrative boundaries of Belgium Brussels, specifically the Brussels-Capital Region.
4.2 The Doctor General Practitioner warrants that all medical services shall be performed in strict accordance with the Belgian Code of Medical Ethics, the RIZIV/INAMI tariff schedule, and the professional standards set by the Brussels-Capital Region Health Authority. The Doctor General Practitioner shall maintain valid professional registration and liability insurance throughout the duration of this Purchase Order.
4.3 Payment shall be made within thirty (30) calendar days of receipt of a valid invoice referencing this Purchase Order number (PO-BE-BRU-2025-04782). Payment shall be processed via bank transfer to the account designated by the Doctor General Practitioner. The IBAN must be a Belgian bank account (BE prefix).
4.4 The Doctor General Practitioner shall maintain full patient confidentiality in compliance with the Belgian Data Protection Act (Law of 30 July 2018) and the EU General Data Protection Regulation (GDPR). All patient records generated under this Purchase Order shall be stored in the Belgian eHealth platform (MyCareNet) and shall not be transferred outside the European Economic Area.
4.5 In the event of non-performance, partial performance, or breach of professional standards by the Doctor General Practitioner, the Purchasing Entity reserves the right to withhold payment, request corrective action, or terminate this Purchase Order with immediate written notice, in accordance with Belgian contract law (Code Civil, Articles 1101–1216).
4.6 Any disputes arising from this Purchase Order shall be resolved by the competent courts of Brussels, Belgium. The applicable law is Belgian law. The parties agree to attempt mediation through the Brussels Mediation Centre before initiating any judicial proceedings.
4.7 This Purchase Order may be amended only by mutual written agreement signed by both parties. No oral modifications shall be valid. All amendments must reference the original Purchase Order number.
4.8 The Doctor General Practitioner shall submit a monthly activity report detailing the number of consultations, home visits, and administrative documents produced under this Purchase Order. Reports shall be submitted by the 5th business day of the following month to the procurement office in Belgium Brussels.
5. Acceptance and Signatures Dr. Catherine Vermeulen Head of Procurement, Hôpital Régional de Bruxelles Date: 14 June 2025 Dr. Marc-Antoine Delacroix, MD Doctor General Practitioner — Rue de la Loi 112, 1040 Brussels Date: _______________Document reference: PO-BE-BRU-2025-04782 | Issued in Belgium Brussels | Language of the contract: English (with Belgian legal terminology) | This Purchase Order is issued in one (1) original and two (2) copies.
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