Purchase Order Surgeon in Brazil Brasília –Free Word Template Download with AI
Document Reference: PO-BSB-2025-04871
Issuing Entity: Hospital das Forças Armadas – Brasília, Brazil
Classification: Medical Professional Services – Surgical Contract
1. PURCHASER INFORMATIONEntity: Hospital das Forças Armadas – HFA
Address: Praça do Exército, s/n – Setor Militar Central, Brasília – DF, CEP 70620-000, Brazil
CNPJ: 00.394.521/0001-88
Authorized Representative: Dr. Carlos Eduardo Menezes, Chief of Surgery
Contact: [email protected] | +55 (61) 3421-7800
2. SUPPLIER / CONTRACTED SURGEON INFORMATIONProfessional Name: Dr. Helena Vasconcelos Ribeiro, M.D., Ph.D.
Specialty: Cardiothoracic and Vascular Surgery
CRM Registration: CRM-DF 48.721
RQE (Registro de Qualificação de Especialista): RQE-DF 12.345 – Cardiovascular Surgery
Address: Quadra 308, Lote 12, Asa Norte, Brasília – DF, CEP 70308-000, Brazil
CPF: ***.482.***-09
Contact: [email protected] | +55 (61) 99876-4321
3. Download and customize a professional Purchase Order Surgeon Brazil Brasília Word template. Perfect for business, legal, and personal use. Editable and ready to boost your productivity. OF SERVICES AND LINE ITEMS| Item | Description | Quantity | Unit Price (BRL) | Total (BRL) | Delivery / Service Date |
|---|---|---|---|---|---|
| 01 | Surgeon on-call availability – Cardiothoracic emergency response at Hospital das Forças Armadas, Brasília. Includes 24/7 standby for critical cardiac and vascular emergencies. The Surgeon shall be physically present at the Brasília facility within 45 minutes of activation. | 1 (monthly retainer) | R$ 48,500.00 | R$ 48,500.00 | 01 Jul 2025 – 31 Jul 2025 |
| 02 | Surgeon surgical procedure – Elective aortic valve replacement (AVR) with cardiopulmonary bypass. The Surgeon shall perform the full operative procedure including pre-operative assessment, intra-operative management, and immediate post-operative monitoring for a minimum of 48 hours. All surgical instruments and implants to be provided by the hospital. | 3 procedures | R$ 32,000.00 | R$ 96,000.00 | 07, 14, 21 Jul 2025 |
| 03 | Surgeon post-operative follow-up consultations – Comprehensive clinical evaluation of all patients operated upon by the Surgeon during the contract period. Includes wound inspection, imaging review, medication adjustment, and discharge clearance. Minimum of 3 follow-up visits per patient. | 9 consultations | R$ 1,850.00 | R$ 16,650.00 | Jul – Sep 2025 |
| 04 | Surgeon academic and training sessions – The Surgeon shall conduct two (2) in-service training workshops for the resident surgical team at the Brasília hospital, covering advanced minimally invasive cardiac techniques and intra-operative complication management. Each session shall last a minimum of 4 hours. | 2 sessions | R$ 8,200.00 | R$ 16,400.00 | 18 & 25 Jul 2025 |
| 05 | Surgeon telemedicine consultation – Remote second-opinion review of complex vascular cases referred from regional hospitals in the Federal District. The Surgeon shall provide written clinical recommendations within 24 hours of case submission. | 12 consultations | R$ 950.00 | R$ 11,400.00 | Jul – Sep 2025 |
| SUBTOTAL: | R$ 188,950.00 | ||||
| ICMS / Applicable Tax (5%): | R$ 9,447.50 | ||||
| GRAND TOTAL (BRL): | R$ 198,397.50 | ||||
- This Purchase Order constitutes a binding agreement between the Purchaser and the contracted Surgeon for the provision of surgical and related medical services at the Hospital das Forças Armadas facility located in Brasília, Distrito Federal, Brazil. All services shall be rendered in accordance with the standards established by the Conselho Federal de Medicina (CFM) and the local regulatory body, the Conselho Regional de Medicina do Distrito Federal (CRM-DF).
- The Surgeon warrants that all professional qualifications, CRM registration, and RQE speciality credentials listed in Section 2 are current, valid, and in good standing for the entire duration of this Purchase Order. Any lapse in registration shall constitute immediate grounds for termination without penalty to the Purchaser.
- The Surgeon shall comply with all data protection obligations under the Brazilian General Data Protection Law (Lei Geral de Proteção de Dados – LGPD, Law No. 13.709/2018) regarding patient medical records, imaging, and personal health information processed during the course of this engagement in Brasília.
- All surgical procedures referenced in this Purchase Order shall be performed in the operating theatres of the Hospital das Forças Armadas, Brasília. The hospital shall provide all necessary surgical instruments, implants, anaesthetic support, nursing staff, and post-operative care facilities. The Surgeon is responsible solely for the clinical execution of the procedure and direct patient management.
- Payment shall be made via bank transfer (TED/DOC) to the account designated by the Surgeon within thirty (30) calendar days of receipt of a valid invoice (nota fiscal) issued in accordance with Brazilian tax regulations. Late payments shall accrue interest at the rate of 1% per month plus SELIC index adjustment.
- The Surgeon shall maintain professional liability insurance (seguro de responsabilidade civil profissional) with a minimum coverage of R$ 2,000,000.00 for the entire contract period. A certificate of insurance shall be provided to the Purchaser prior to the commencement of services in Brasília.
- Either party may terminate this Purchase Order with thirty (30) days written notice. In the event of termination, the Surgeon shall be compensated for all services rendered up to the effective date of termination, and the Purchaser shall not be liable for any projected future services.
- This Purchase Order shall be governed by and construed in accordance with the laws of the Federative Republic of Brazil. Any disputes arising from this agreement shall be subject to the exclusive jurisdiction of the courts of Brasília, Distrito Federal, Brazil.
- The Surgeon acknowledges that all patient records, surgical reports, and clinical documentation generated during the performance of this Purchase Order shall become the property of the Hospital das Forças Armadas and shall be maintained in the hospital's medical records system in Brasília.
For the Purchaser (Hospital das Forças Armadas – Brasília):
Name: Dr. Carlos Eduardo Menezes
Title: Chief of Surgery / Procurement Authority
Signature: ______________________________
Date: 14/06/2025
For the Surgeon (Contracted Professional):
Name: Dr. Helena Vasconcelos Ribeiro, M.D., Ph.D.
Title: Cardiothoracic and Vascular Surgeon
Signature: ______________________________
Date: 14/06/2025
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