Purchase Order Psychiatrist in Venezuela Caracas –Free Word Template Download with AI
Medical Services Procurement Department
Clínica Integral del Este, C.A.
Av. Francisco de Miranda, Torre Este, Piso 12, Chacao, Venezuela Caracas
RIF: J-30458721-9 | Tel: +58 (212) 555-0147 | Email: [email protected]
1. VENDOR / SERVICE PROVIDER INFORMATIONProvider Name: Dr. María Alejandra Rodríguez Fernández, M.D., Psiquiatra
Specialty: Psychiatrist – Adult and Adolescent Psychiatry, Psychopharmacology
Professional License: Cédula Profesional No. 12.847.563 (Ministerio del Poder Popular para la Salud, Venezuela)
Practice Address: Consultorio Psiquiátrico "Mente Sana", Av. Páez, Edif. Centro Médico, Piso 4, Oficina 402, El Rosal, Venezuela Caracas, 1060
Contact Phone: +58 (212) 555-0392
Email: [email protected]
RIF (Provider): V-12.847.563-2
2. BILL-TO / REQUISITIONING DEPARTMENTDepartment: Department of Mental Health and Behavioral Sciences
Requisitioned By: Lic. Carlos A. Mendoza, Head of Clinical Operations
Approved By: Dr. Luis Enrique Vargas, Medical Director
Facility Location: Clínica Integral del Este, C.A., Venezuela Caracas
3. Download and customize a professional Purchase Order Psychiatrist Venezuela Caracas Word template. Perfect for business, legal, and personal use. Editable and ready to boost your productivity. OF SERVICES – LINE ITEMS| Item | Description of Psychiatric Service | Qty / Sessions | Unit Price (USD) | Total (USD) | Frequency / Period |
|---|---|---|---|---|---|
| 01 | Initial comprehensive psychiatric evaluation and diagnostic assessment (DSM-5-TR) for adult patients referred by the internal medicine department. Includes clinical interview, mental status examination, and initial treatment plan formulation. | 40 | $185.00 | $7,400.00 | Monthly, Jul–Dec 2025 |
| 02 | Follow-up psychiatric consultation sessions (45 minutes) for ongoing patient management, medication titration, and therapeutic progress monitoring. Conducted by the assigned Psychiatrist at the Venezuela Caracas clinic facility. | 160 | $120.00 | $19,200.00 | Bi-weekly per patient |
| 03 | Psychopharmacological management and prescription of controlled substances (Schedule II–V) in compliance with Venezuelan Ministry of Health regulations. Includes quarterly medication review and laboratory monitoring coordination. | 80 | $95.00 | $7,600.00 | Monthly |
| 04 | Adolescent psychiatric assessment and family therapy sessions (90 minutes) for patients aged 13–17. Delivered by the Psychiatrist in a dedicated consultation room at the Venezuela Caracas location. | 30 | $210.00 | $6,300.00 | Weekly per enrolled family |
| 05 | Emergency psychiatric consultation and crisis intervention (on-call availability, 24/7 coverage for the Venezuela Caracas facility). Includes same-day evaluation, risk assessment, and disposition recommendations. | 12 | $350.00 | $4,200.00 | As needed (estimated) |
| 06 | Interdisciplinary case conference participation and written clinical reports for the Mental Health Board of Clínica Integral del Este. The Psychiatrist shall attend bi-weekly multidisciplinary meetings and submit detailed progress notes within 48 hours. | 26 | $75.00 | $1,950.00 | Bi-weekly |
Subtotal: $46,650.00 USD
IVA (16% VAT – Venezuela): $7,464.00 USD
GRAND TOTAL: $54,114.00 USD
4. TERMS AND CONDITIONS- This Purchase Order authorizes the contracted Psychiatrist to render the psychiatric services described herein at the Clínica Integral del Este facility located in Venezuela Caracas. All services must be performed in accordance with the standards established by the Venezuelan Ministry of Health (MPPS) and the Colegio de Médicos del Estado Miranda.
- The Psychiatrist shall maintain valid professional licensure, malpractice insurance (minimum coverage of USD 500,000), and all required certifications throughout the duration of this Purchase Order. Any lapse in licensure shall constitute grounds for immediate termination.
- All patient records, clinical notes, and diagnostic reports generated under this Purchase Order shall be maintained in the facility's electronic health record system (EHR) and shall remain the property of Clínica Integral del Este, C.A. The Psychiatrist shall comply with Venezuelan data protection law (Ley Orgánica de Protección de Datos Personales, 2012).
- Payment shall be processed within thirty (30) calendar days from the date of invoice submission. Invoices must include the Psychiatrist's RIF, a detailed itemization of services rendered, and the corresponding Purchase Order number (PO-2025-VC-00847). Payments will be made via bank transfer to the account designated by the provider.
- The Psychiatrist is engaged as an independent contractor and not as an employee of Clínica Integral del Este. The Psychiatrist shall be responsible for all applicable income taxes, social security contributions (IVSS), and professional obligations under Venezuelan labor and tax law.
- Any modification to the scope of services, session frequency, or pricing under this Purchase Order must be documented in a written amendment signed by both parties. Verbal agreements shall not be binding.
- This Purchase Order is valid for a period of six (6) months from the date of issue, covering the period July 1, 2025 through December 31, 2025. Renewal shall be subject to mutual written agreement and satisfactory performance evaluation.
- In the event of force majeure, including but not limited to natural disasters, civil unrest, or government-mandated closures affecting the Venezuela Caracas metropolitan area, either party may suspend obligations with 48-hour written notice without penalty.
- Disputes arising from this Purchase Order shall be resolved through mediation in Venezuela Caracas before submission to the competent commercial courts of the state of Miranda, Venezuela.
Lic. Carlos A. Mendoza
Head of Clinical Operations
Date: _______________ Approved By:
Dr. Luis Enrique Vargas, M.D.
Medical Director
Date: _______________ Accepted By (Provider):
Dr. María Alejandra Rodríguez Fernández, M.D.
Psychiatrist
Date: _______________ Finance Acknowledgment:
Lic. Ana Teresa Gutiérrez
Director of Finance & Procurement
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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