Purchase Order Radiologist in Brazil Brasília –Free Word Template Download with AI
MedBrasília Diagnostic Imaging Center Ltda.
Quadra 1, Bloco A, Lote 12, Asa Sul, Brasília – DF, Brazil, CEP 70304-900
CNPJ: 12.345.678/0001-90 | Phone: +55 (61) 3344-5566 | Email: [email protected]
| Field | Details |
|---|---|
| Professional Name | Dr. Helena Vasconcelos Ribeiro, M.D., Ph.D. – Radiologist |
| Registration (CRM) | CRM-DF 45.678 |
| Specialty Registration (RQE) | RQE Radiologia e Diagnóstico por Imagem – 12.345 |
| Professional Address | SHIS QI 5, Lote 3, Casa 7, Lago Sul, Brasília – DF, Brazil, CEP 71620-050 |
| Contact Phone | +55 (61) 99876-5432 |
| [email protected] | |
| Bank for Payment | Banco do Brasil S.A. – Ag. 1234-5 – Conta Corrente 98.765-4 |
This Purchase Order is issued by MedBrasília Diagnostic Imaging Center Ltda. to formally engage the services of a qualified Radiologist for the provision of diagnostic imaging interpretation, clinical reporting, and on-site consultation at our facility located in Brazil Brasília, specifically at the Asa Sul campus. The Radiologist shall perform all duties in accordance with the standards established by the Conselho Federal de Medicina (CFM) and the specific regulations governing radiological practice in the Federal District of Brazil Brasília.
| Item # | Description of Service | Quantity / Period | Unit Price (BRL) | Total (BRL) |
|---|---|---|---|---|
| 01 | Full-time Radiologist on-site service – interpretation of CT, MRI, X-ray, and ultrasound examinations at the Brasília – DF facility | 12 months (July 2025 – June 2026) | R$ 38,500.00 | R$ 462,000.00 |
| 02 | Emergency Radiologist on-call coverage (24/7 rotation) – minimum 4 on-call shifts per month at the Brazil Brasília hospital network | 48 shifts | R$ 1,200.00 | R$ 57,600.00 |
| 03 | Interdepartmental consultation and multidisciplinary tumor board participation – Radiologist input for oncology and neurology cases in Brazil Brasília | 24 sessions | R$ 850.00 | R$ 20,400.00 |
| 04 | Quality assurance and peer review of imaging reports – monthly audit of Radiologist reports for compliance with CFM and ABR (Associação Brasileira de Radiologia) standards | 12 months | R$ 2,500.00 | R$ 30,000.00 |
| 05 | Continuing medical education and certification maintenance – Radiologist attendance at ABR congress and CFM-accredited courses in Brazil Brasília or approved remote venues | 12 months | R$ 3,200.00 | R$ 38,400.00 |
| TOTAL AMOUNT (BRL) | R$ 608,400.00 | |||
| Applicable Tax – ISS (Imposto Sobre Serviços) – Brasília – DF (3%) | R$ 18,252.00 | |||
| GRAND TOTAL (BRL) | R$ 626,652.00 | |||
- Scope of Engagement: This Purchase Order authorizes the contracted Radiologist to perform all diagnostic imaging interpretation services at the MedBrasília facility in Brazil Brasília. The Radiologist shall maintain valid CRM and RQE registrations throughout the contract period and shall notify the purchasing department within 48 hours of any change in professional status.
- Payment Terms: Payment shall be made via bank transfer (TED/DOC) to the account specified in Section 1, within 30 (thirty) calendar days from the date of invoice issuance. Invoices must reference this Purchase Order number (PO-2025-04871) and include the CNPJ/CPF of the Radiologist and the applicable ISS tax code for Brazil Brasília.
- Service Location: All on-site services shall be rendered at the MedBrasília Diagnostic Imaging Center, Quadra 1, Bloco A, Lote 12, Asa Sul, Brazil Brasília – DF. The Radiologist may also provide remote interpretation services for partner clinics in the Federal District as directed by the Medical Director.
- Confidentiality and Data Protection: The Radiologist shall comply with the Brazilian General Data Protection Law (LGPD – Lei Geral de Proteção de Dados, Lei nº 13.709/2018) and all CFM ethical guidelines regarding patient confidentiality. All imaging data and patient records generated in Brazil Brasília shall be stored on the facility's secure PACS system and shall not be transferred outside the institution without written authorization.
- Termination: Either party may terminate this Purchase Order with 60 (sixty) days' written notice. In the event of termination, the Radiologist shall complete all pending reports and hand over patient files to the successor Radiologist within 15 (fifteen) business days.
- Liability and Insurance: The Radiologist shall maintain professional liability insurance (Seguro de Responsabilidade Civil Profissional) with a minimum coverage of R$ 500,000.00 per claim, valid throughout the contract period. The insurance policy must name MedBrasília Diagnostic Imaging Center Ltda. as an additional insured party.
- Governing Law: This Purchase Order shall be governed by the laws of the Federative Republic of Brazil, with jurisdiction vested in the courts of Brazil Brasília – DF. Any disputes arising from this agreement shall be resolved in the competent judicial or arbitral forum in Brazil Brasília.
- Amendments: Any modification to the scope, pricing, or duration of services under this Purchase Order must be documented in a written addendum signed by both parties. Verbal agreements regarding the Radiologist's duties or compensation shall not be enforceable.
This Purchase Order has been reviewed and approved by the undersigned authorized representatives of MedBrasília Diagnostic Imaging Center Ltda. The engagement of the Radiologist is effective from 1 July 2025 and shall continue until 30 June 2026, unless terminated earlier in accordance with the terms stated herein. The services described in this document are integral to the diagnostic imaging operations of our facility in Brazil Brasília and are essential to maintaining the quality of care provided to patients in the Federal District.
Prepared by:Carlos Eduardo Martins
Procurement Manager
MedBrasília Diagnostic Imaging Center Ltda.
Date: 15/06/2025 Approved by:
Dra. Fernanda Oliveira Costa
Medical Director
MedBrasília Diagnostic Imaging Center Ltda.
Date: 15/06/2025 Accepted by (Radiologist):
Dr. Helena Vasconcelos Ribeiro, M.D., Ph.D.
CRM-DF 45.678
Date: ____________ Finance Verification:
Ana Paula Rodrigues
Financial Controller
MedBrasília Diagnostic Imaging Center Ltda.
Date: 15/06/2025 ⬇️ Download as DOCX Edit online as DOCX
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