Purchase Order Psychiatrist in Brazil Brasília –Free Word Template Download with AI
Psychiatric Professional Services — Brazil Brasília
Document Reference: PO-PSY-2025-00472
Issuing Organization| Organization Name: Instituto de Saúde Mental do Planalto Central | CNPJ: 12.345.678/0001-90 |
| Address: SHLS 716, Bloco B, Sala 402, Asa Sul, Brasília — DF, 70390-716 | Contact: [email protected] |
| Authorized Representative: Dra. Helena Vasconcelos, Chief Procurement Officer | Phone: +55 (61) 3344-5566 |
| Provider Name: Dr. Ricardo Almeida Ferreira, Psychiatrist | CRM-DF: 28.4561 |
| Specialization: Adult and Adolescent Psychiatry, Psychopharmacology | Registration: RQE 45.678 (Psiquiatria) |
| Clinic Address: QNM 11, Lote 2, Sala 305, Asa Norte, Brasília — DF, 70790-000 | Contact: [email protected] |
This Purchase Order formally authorizes the engagement of a qualified Psychiatrist to provide comprehensive psychiatric evaluation, diagnosis, and ongoing therapeutic services to the employees and dependents of Instituto de Saúde Mental do Planalto Central. The Psychiatrist shall render all professional services within the jurisdiction of Brazil Brasília, specifically at the designated clinical facility located in the Setor Médico-Hospitalar Sul district. The Psychiatrist is expected to adhere to all ethical guidelines established by the Conselho Federal de Medicina (CFM) and the Conselho Regional de Medicina do Distrito Federal (CRM-DF).
Line Items — Services Ordered| Item # | Description of Service | Quantity | Unit | Unit Price (BRL) | Total (BRL) |
|---|---|---|---|---|---|
| 01 | Initial comprehensive psychiatric evaluation and diagnostic assessment per employee (includes anamnesis, mental status examination, and diagnostic formulation) | 120 | Sessions | R$ 450,00 | R$ 54.000,00 |
| 02 | Follow-up psychiatric consultation sessions (45-minute appointments for ongoing treatment monitoring and medication adjustment) | 480 | Sessions | R$ 380,00 | R$ 182.400,00 |
| 03 | Psychopharmacological prescription management and quarterly medication review for patients under active psychiatric care | 96 | Reviews | R$ 250,00 | R$ 24.000,00 |
| 04 | Emergency psychiatric consultation and crisis intervention services (on-call availability, 24/7 coverage within Brazil Brasília metropolitan area) | 12 | Months | R$ 3.500,00 | R$ 42.000,00 |
| 05 | Group psychoeducation workshops on mental health awareness, stress management, and psychiatric condition literacy (monthly sessions for employee groups of up to 25) | 12 | Workshops | R$ 1.800,00 | R$ 21.600,00 |
| 06 | Written clinical reports and psychiatric fitness-for-work assessments for occupational health compliance (issued per request) | 60 | Reports | R$ 200,00 | R$ 12.000,00 |
| GRAND TOTAL (BRL): | R$ 336.000,00 | ||||
- This Purchase Order is valid for a period of twelve (12) months from the date of issue, covering the full cycle of psychiatric services to be delivered by the Psychiatrist at the designated facility in Brazil Brasília.
- The Psychiatrist shall maintain valid professional registration with the CRM-DF and shall provide proof of continued registration upon request. Any lapse in registration shall constitute grounds for immediate termination of this Purchase Order without penalty to the issuing organization.
- All services rendered under this Purchase Order shall comply with the Brazilian General Data Protection Law (LGPD — Lei Geral de Proteção de Dados, Law No. 13.709/2018) regarding the handling of sensitive patient health information.
- Payment terms: Net 30 days from the date of invoice submission. Invoices shall be submitted monthly, itemized by service category, and accompanied by a summary of sessions conducted. Payment shall be made via bank transfer to the account designated by the Psychiatrist.
- The Psychiatrist is required to submit a monthly activity report detailing the number of patients seen, types of interventions performed, and any notable clinical observations relevant to the organization's occupational health program.
- Confidentiality: The Psychiatrist shall maintain strict professional confidentiality in accordance with the CFM Code of Medical Ethics. No patient information shall be disclosed to third parties without written consent, except as required by law.
- Subcontracting: The Psychiatrist shall not subcontract any portion of the services outlined in this Purchase Order without prior written approval from the issuing organization.
- Termination: Either party may terminate this Purchase Order with thirty (30) days written notice. In the event of termination, the Psychiatrist shall ensure continuity of care for all active patients and provide appropriate referral documentation.
- Governing Law: This Purchase Order shall be governed by and interpreted in accordance with the laws of the Federative Republic of Brazil, with jurisdiction vested in the courts of Brazil Brasília, Distrito Federal.
- Taxes: All applicable taxes, including ISS (Imposto Sobre Serviços) levied by the municipality of Brazil Brasília, shall be the responsibility of the Psychiatrist as the service provider, in accordance with Brazilian tax legislation.
Dra. Helena Vasconcelos
Chief Procurement Officer
Instituto de Saúde Mental do Planalto Central
Date: ______________________ For the Service Provider (Psychiatrist)
Dr. Ricardo Almeida Ferreira
Psychiatrist — CRM-DF 28.4561
Date: ______________________ ⬇️ Download as DOCX Edit online as DOCX
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