Purchase Order Orthodontist in Brazil Rio de Janeiro –Free Word Template Download with AI
Orthodontic Services & Clinical Supplies Procurement
Issued in Brazil, Rio de Janeiro — State of Rio de Janeiro, Federal Republic of Brazil
PO No. RJ-ORT-2025-04871Purchasing Entity
Clínica Odontológica Rio Sorriso Ltda.
Av. Atlântica, 1250 — Copacabana
Rio de Janeiro, RJ — CEP 22070-001
Brazil
CNPJ: 12.345.678/0001-90
Contact: [email protected]
Phone: +55 (21) 3456-7890
Supplier / Orthodontist Provider
Dr. Mariana Costa Ferreira — Orthodontist
CRO-RJ: 45.678
R. Visconde de Pirajá, 890 — Ipanema
Rio de Janeiro, RJ — CEP 22410-003
Brazil
Contact: [email protected]
Phone: +55 (21) 99876-5432
Order Details
Purchase Order Date: 15 June 2025
Required Delivery / Service Start: 01 July 2025
Payment Terms: Net 30 days from invoice date
Currency: Brazilian Real (BRL / R$)
Valid Until: 30 June 2025
Project Reference
Project: Community Orthodontic Program — Rio de Janeiro
Ref. No.: PROJ-ORT-RJ-2025-003
Authorized By: Dr. Paulo Henrique Santos, CEO
Department: Clinical Procurement — Rio de Janeiro Office
| # | Description | Qty | Unit (BRL) | Total (BRL) | Delivery / Due |
|---|---|---|---|---|---|
| 1 | Comprehensive orthodontic consultation and diagnostic imaging (panoramic X-ray, cephalometric analysis) for 120 patients — Orthodontist Dr. Costa to perform all evaluations at the Rio de Janeiro clinic facility. | 120 | R$ 350.00 | R$ 42,000.00 | 01 Jul 2025 |
| 2 | Custom-fabricated orthodontic appliances (lingual retainers, expansion plates, and functional regulators) manufactured per the Orthodontist's specifications for pediatric and adolescent patients in the Rio de Janeiro program. | 85 | R$ 1,200.00 | R$ 102,000.00 | 15 Jul 2025 |
| 3 | Self-ligating orthodontic brackets (0.022" slot, stainless steel and ceramic) — 200 complete sets including archwires, ligatures, and molar bands, to be supplied to the Orthodontist's operating room in Ipanema, Rio de Janeiro. | 200 | R$ 480.00 | R$ 96,000.00 | 10 Jul 2025 |
| 4 | Monthly orthodontic adjustment sessions (12-month treatment cycle) — The Orthodontist shall provide 12 scheduled adjustment appointments per patient for a cohort of 60 patients, conducted at the Rio de Janeiro clinic. | 720 | R$ 180.00 | R$ 129,600.00 | Jul 2025 – Jun 2026 |
| 5 | Digital intraoral scanning and 3D treatment planning software license (1-year subscription) for the Orthodontist's practice in Rio de Janeiro, including cloud storage and remote consultation access. | 1 | R$ 18,500.00 | R$ 18,500.00 | 01 Jul 2025 |
| 6 | Orthodontic emergency and follow-up visits (unplanned) — Provisional allocation of up to 30 emergency sessions to be performed by the Orthodontist or designated associate in the Rio de Janeiro facility. | 30 | R$ 250.00 | R$ 7,500.00 | As needed |
| 7 | Patient education materials and aftercare kits (elastics, wax, cleaning instructions in Portuguese) — 120 kits to be distributed by the Orthodontist's team at each initial appointment in Rio de Janeiro. | 120 | R$ 45.00 | R$ 5,400.00 | 01 Jul 2025 |
Subtotal: R$ 401,000.00
ICMS (18% — State of Rio de Janeiro): R$ 72,180.00
PIS/COFINS (9.25%): R$ 37,092.50
Grand Total: R$ 510,272.50
Terms and Conditions
- This Purchase Order is issued in accordance with Brazilian commercial law (Código Civil Brasileiro, Lei 10.406/2002) and all applicable regulations of the State of Rio de Janeiro.
- The Orthodontist, Dr. Mariana Costa Ferreira, shall perform all clinical services in full compliance with the Conselho Regional de Odontologia do Rio de Janeiro (CRO-RJ) ethical and professional standards.
- All orthodontic materials and supplies listed in this Purchase Order must meet ANVISA (Agência Nacional de Vigilância Sanitária) registration requirements and be delivered to the designated facility in Rio de Janeiro, Brazil.
- Payment shall be processed via bank transfer (TED/PIX) to the account specified by the Orthodontist within 30 calendar days of receipt of a valid invoice (nota fiscal) issued in the State of Rio de Janeiro.
- The Orthodontist shall provide monthly progress reports detailing patient outcomes, appliance adjustments, and any deviations from the original treatment plan to the purchasing entity's clinical director in Rio de Janeiro.
- Any modification to the scope of services, quantities, or delivery timelines must be documented in a written amendment to this Purchase Order, signed by both parties, and filed with the Rio de Janeiro office records.
- In the event of non-performance or breach, the purchasing entity reserves the right to terminate this Purchase Order with 15 days' written notice, in accordance with Brazilian contract law.
- All patient data collected during the orthodontic treatment process shall be handled in strict compliance with the Brazilian General Data Protection Law (LGPD — Lei 13.709/2018).
- This Purchase Order is valid for acceptance until 30 June 2025. Failure to confirm acceptance by this date shall render this document null and void.
For the Purchasing Entity
Clínica Odontológica Rio Sorriso Ltda.
Dr. Paulo Henrique SantosChief Executive Officer
Rio de Janeiro, RJ — Brazil
Date: _______________
For the Orthodontist / Supplier
Dr. Mariana Costa Ferreira — CRO-RJ 45.678
Dr. Mariana Costa FerreiraOrthodontist — Ipanema, Rio de Janeiro
Brazil
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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