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Purchase Order Psychiatrist in Belgium Brussels –Free Word Template Download with AI

MediCare Brussels Group S.A.

12 Avenue Louise, 1050 Brussels, Belgium

VAT No.: BE 0765.432.109 | IBAN: BE68 5390 0754 7034 | BIC: GEBABEBB

Phone: +32 2 555 0142 | Email: [email protected]

Purchase Order No.: PO-2025-BRU-0487
Date of Issue: 14 June 2025
Valid Until: 14 July 2025
Supplier / Service Provider:
Dr. Annelise Vermeulen, Psychiatrist
Cabinet de Psychiatrie Vermeulen
45 Rue de la Loi, 1040 Brussels, Belgium
RIZIV/INAMI No.: 501.234.567
VAT No.: BE 0812.567.890
Department: Mental Health Services
Cost Centre: CC-PSY-2025-003
Priority: Standard

This Purchase Order is issued by MediCare Brussels Group S.A. to engage the professional services of Dr. Annelise Vermeulen, a licensed Psychiatrist registered with the Belgian RIZIV/INAMI authority, to provide comprehensive psychiatric evaluation, diagnosis, and ongoing therapeutic treatment for the organisation's employees. All services rendered under this Purchase Order shall be delivered at the supplier's practice located in Belgium Brussels, specifically at 45 Rue de la Loi, 1040 Brussels, or at such other location within the Brussels-Capital Region as mutually agreed upon in writing. The Psychiatrist shall comply with all applicable Belgian healthcare regulations, including those governed by the Belgian Federal Public Health Service and the professional code of ethics established by the Belgian Psychiatric Association.

Ref. Service Description Qty Unit Unit Price (EUR) Total (EUR)
01 Initial psychiatric assessment and diagnostic consultation (90 minutes) – Psychiatrist session in Belgium Brussels 12 Session 185.00 2,220.00
02 Follow-up psychiatric therapy session (60 minutes) – Psychiatrist ongoing treatment 48 Session 145.00 6,960.00
03 Psychiatric medication review and prescription management (30 minutes) 24 Session 95.00 2,280.00
04 Urgent psychiatric consultation – same-day availability in Belgium Brussels 4 Session 220.00 880.00
05 Written psychiatric report and medical certificate for employer (per employee) 12 Report 75.00 900.00
06 Group psychoeducational workshop led by the Psychiatrist (3 hours, up to 15 participants) 2 Workshop 650.00 1,300.00
Subtotal (excl. VAT) 14,540.00 EUR
VAT (21% – Belgian standard rate) 3,053.40 EUR
Grand Total (incl. VAT) 17,593.40 EUR
  • 3.1 Scope of Engagement: The Psychiatrist shall provide all services listed in Section 2 in accordance with the Belgian Code of Economic Law and the professional standards set by the Belgian Psychiatric Association. All consultations shall take place in Belgium Brussels unless otherwise specified in writing by both parties.
  • 3.2 Confidentiality and Data Protection: The Psychiatrist shall handle all patient data in strict compliance with the Belgian Data Protection Act (Law of 30 July 2018) and the European General Data Protection Regulation (GDPR). No patient information shall be disclosed to MediCare Brussels Group S.A. beyond the scope of the written medical certificates specified in Line Item 05.
  • 3.3 Payment Terms: Payment shall be made within 30 calendar days of receipt of a valid invoice. Invoices shall be submitted to the procurement department of MediCare Brussels Group S.A. Payment shall be executed via bank transfer to the IBAN specified on the supplier's invoice. Late payments shall accrue interest at the rate prescribed by the Belgian Law of 2 August 2002 on late payment in commercial transactions.
  • 3.4 Cancellation and Rescheduling: Appointments may be rescheduled up to 48 hours in advance without penalty. Cancellations made less than 48 hours prior to a scheduled session shall be billed at 50% of the applicable unit price. The Psychiatrist reserves the right to decline or reschedule urgent consultations in cases of force majeure.
  • 3.5 Professional Liability and Insurance: The Psychiatrist shall maintain valid professional liability insurance with a minimum coverage of EUR 1,000,000 per claim, as required by Belgian medical professional regulations. A certificate of insurance shall be provided upon request.
  • 3.6 Governing Law and Jurisdiction: This Purchase Order shall be governed by and construed in accordance with the laws of Belgium. Any disputes arising from or in connection with this Purchase Order shall be submitted to the exclusive jurisdiction of the competent courts of Brussels, Belgium Brussels.
  • 3.7 Termination: Either party may terminate this Purchase Order with 30 days' written notice. Services already rendered and invoiced prior to the effective date of termination shall remain payable in full.
  • 3.8 Anti-Corruption: Both parties warrant compliance with all applicable Belgian and EU anti-corruption and anti-bribery legislation. Any breach of this clause shall constitute grounds for immediate termination of this Purchase Order.

By signing below, both parties acknowledge and agree to the terms, conditions, and service specifications outlined in this Purchase Order. This document constitutes a binding agreement for the provision of Psychiatrist services within the Belgium Brussels region for the duration specified herein.

For and on behalf of MediCare Brussels Group S.A.:

Name: Mr. Johan Peeters
Title: Chief Procurement Officer
Signature: _________________________
Date: _________________________

For and on behalf of the Psychiatrist / Supplier:

Name: Dr. Annelise Vermeulen
Title: Psychiatrist, RIZIV/INAMI 501.234.567
Signature: _________________________
Date: _________________________

This Purchase Order (PO-2025-BRU-0487) is issued by MediCare Brussels Group S.A., Belgium Brussels. All services are to be performed in accordance with Belgian healthcare regulations. This document is valid for 30 days from the date of issue. For queries, contact [email protected] or +32 2 555 0142.

Document generated on 14 June 2025 | Page 1 of 1 | Confidential – For authorised use only

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