Purchase Order Psychiatrist in Colombia Bogotá –Free Word Template Download with AI
Clínica Integral de Salud Mental S.A.S.
Calle 72A No. 11-45, Piso 8, Zona Rosa, Bogotá D.C., Colombia
NIT: 901.234.567-8 | RUT: 9012345678 | Tel: +57 (601) 745 8920
Email: [email protected] | Web: www.clinicasaludmental.co
| Field | Details |
|---|---|
| Provider Name: | Dr. Mariana Alejandra Restrepo Gómez, M.D. – Psychiatrist |
| Professional License: | Registro Calificado No. 2019-PSY-45821, issued by the Colombian Ministry of Health (Ministerio de Salud y Protección Social) |
| Specialty: | General Psychiatry, Adult Psychopharmacology, and Cognitive Behavioral Therapy |
| Practice Address: | Carrera 15 No. 85-22, Of. 304, Chapinero, Bogotá D.C., Colombia |
| NIT / Tax ID: | 1.034.567.890-1 |
| Contact: | [email protected] | +57 (601) 325 6741 |
This Purchase Order authorizes the procurement of professional psychiatric services rendered by the above-named Psychiatrist at the facility located in Colombia Bogotá. The Psychiatrist shall provide comprehensive mental health evaluation, diagnosis, pharmacological management, and psychotherapeutic intervention for patients referred by the clinic's internal medical team. All services shall be delivered in accordance with the regulations established by the Colombian Ministry of Health and the applicable norms of the Superintendencia Nacional de Salud.
| Item # | Description of Service | Qty | Unit Price (COP) | Total (COP) |
|---|---|---|---|---|
| 001 | Initial psychiatric evaluation and comprehensive diagnostic assessment (90 minutes) | 40 | 350,000 | 14,000,000 |
| 002 | Follow-up psychiatric consultation and treatment plan review (45 minutes) | 120 | 220,000 | 26,400,000 |
| 003 | Psychopharmacological management and medication adjustment session (30 minutes) | 80 | 180,000 | 14,400,000 |
| 004 | Cognitive Behavioral Therapy (CBT) individual session (50 minutes) | 60 | 250,000 | 15,000,000 |
| 005 | Urgent psychiatric consultation for acute episodes (60 minutes, after-hours) | 15 | 450,000 | 6,750,000 |
| 006 | Psychiatric evaluation report for legal or insurance purposes (written documentation) | 20 | 300,000 | 6,000,000 |
| 007 | Interdisciplinary case conference participation with clinical team (2 hours) | 12 | 400,000 | 4,800,000 |
| GRAND TOTAL (COP) | 87,350,000 | |||
| IVA (19% VAT – Colombian Tax) | 16,596,500 | |||
| NET TOTAL PAYABLE (COP) | 103,946,500 | |||
- 4.1 – This Purchase Order is issued by Clínica Integral de Salud Mental S.A.S., a legal entity registered in Colombia Bogotá, and constitutes a binding agreement for the psychiatric services described herein.
- 4.2 – The Psychiatrist shall maintain valid professional registration with the Colombian Ministry of Health and shall provide proof of continued licensure upon request. Any lapse in registration shall immediately suspend the obligations under this Purchase Order.
- 4.3 – All services shall be performed at the clinic's facility in Colombia Bogotá or at the Psychiatrist's registered practice address, as mutually agreed upon for each patient session. Telepsychiatry sessions are permitted under the conditions set forth by the Superintendencia Nacional de Salud.
- 4.4 – The Psychiatrist shall comply with all data protection regulations under Law 1581 of 2012 (Colombian Data Protection Law) and shall ensure the strict confidentiality of all patient records and clinical information.
- 4.5 – Payment shall be made within thirty (30) calendar days from the date of receipt of a valid electronic invoice (Factura Electrónica) issued in compliance with the DIAN (Dirección de Impuestos y Aduanas Nacionales) regulations for Colombia Bogotá.
- 4.6 – The Psychiatrist is responsible for withholding applicable income tax (retención en la fuente) as mandated by Colombian tax law. The clinic shall apply the corresponding withholding at the rate established by the DIAN for professional services.
- 4.7 – In the event of service cancellation by the clinic, a minimum of 24 hours' prior written notice shall be provided. Cancellations by the Psychiatrist must be communicated at least 48 hours in advance to allow for patient reassignment.
- 4.8 – This Purchase Order is valid for a period of ninety (90) days from the date of issue. Any services not rendered within this period shall require a formal amendment or a new Purchase Order.
- 4.9 – Disputes arising from this Purchase Order shall be resolved through the competent courts of Colombia Bogotá, in accordance with Colombian civil and commercial law.
- 4.10 – The Psychiatrist shall carry professional liability insurance (póliza de responsabilidad civil profesional) with a minimum coverage of COP 500,000,000, and shall provide a certificate of coverage prior to the commencement of services.
The Psychiatrist shall be available for patient consultations at the clinic's main facility in Colombia Bogotá, located at Calle 72A No. 11-45, Zona Rosa, from Monday through Friday, between the hours of 8:00 AM and 6:00 PM. After-hours urgent psychiatric consultations shall be coordinated through the clinic's emergency line. The Psychiatrist shall maintain a minimum availability of twenty (20) consultation slots per week for the duration of this Purchase Order.
Prepared by:
Carlos Andrés Mendoza Ríos
Procurement Manager
Clínica Integral de Salud Mental S.A.S.
Signature & DateApproved by:
Dra. Lucía Fernanda Ospina Valdés
Medical Director
Clínica Integral de Salud Mental S.A.S.
Signature & DateAccepted by (Provider):
Dr. Mariana Alejandra Restrepo Gómez
Psychiatrist – M.D.
Registro Calificado No. 2019-PSY-45821
Signature & DateFinancial Verification:
Jorge Iván Cárdenas Peña
Chief Financial Officer
Clínica Integral de Salud Mental S.A.S.
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