Quotation Estimate Doctor General Practitioner in Brazil Brasília –Free Word Template Download with AI
Professional Medical Services – Doctor General Practitioner
Brasília, Distrito Federal – Brazil
Document Reference: QE-BR-BSB-2025-0047
1. Client Information| Field | Details |
|---|---|
| Client / Organization Name | Empresa de Saúde Corporativa Ltda. (CNPJ: 12.345.678/0001-90) |
| Address | Quadra 3, Bloco B, Sala 412 – Asa Sul, Brasília – DF, CEP 70300-000, Brazil |
| Contact Person | Sra. Mariana Costa – Human Resources Director |
| Email / Phone | [email protected] / +55 (61) 3344-5566 |
This Quotation Estimate is issued for the provision of comprehensive primary care services delivered by a licensed Doctor General Practitioner operating within the municipality of Brazil Brasília, specifically in the Asa Sul district. The Doctor General Practitioner will be responsible for the full spectrum of outpatient medical consultations, preventive health assessments, chronic disease management, and referral coordination for the client's corporate health program. All services will be rendered in compliance with the regulations established by the Conselho Federal de Medicina (CFM) and the local health authority of the Distrito Federal.
3. Itemized Cost Breakdown| Item # | Description of Service | Frequency | Unit Price (R$) | Monthly Total (R$) |
|---|---|---|---|---|
| 01 | General Practitioner Consultation – Initial Comprehensive Health Assessment (includes anamnesis, physical examination, and baseline laboratory review) | 1x per employee per year | 450.00 | 4,500.00 |
| 02 | Doctor General Practitioner Follow-Up Consultation – Ongoing Management of Acute and Chronic Conditions (hypertension, diabetes, respiratory disorders, musculoskeletal complaints) | Up to 12 sessions per employee per year | 320.00 | 12,800.00 |
| 03 | Preventive Health Screening Program – Annual Physical Examination, Cardiovascular Risk Assessment, and Vaccination Planning by the Doctor General Practitioner | 1x per employee per year | 680.00 | 6,800.00 |
| 04 | On-Site Corporate Health Visits – Doctor General Practitioner available at client premises in Brasília for bi-weekly half-day consultations (4 hours per visit) | 2x per month | 2,200.00 | 8,800.00 |
| 05 | Telemedicine / Remote Consultation – Doctor General Practitioner available via secure video platform for urgent triage and non-urgent follow-ups within the Brasília metropolitan area | Unlimited (capped at 60 sessions/month) | 180.00 | 10,800.00 |
| 06 | Medical Report and Documentation – Written clinical summaries, fitness-for-work certificates, and referral letters issued by the Doctor General Practitioner | As needed (up to 40 reports/month) | 95.00 | 3,800.00 |
| 07 | Coordination with Specialists – Doctor General Practitioner manages referrals to cardiology, dermatology, orthopedics, and other specialties within the Brasília healthcare network | Included | — | 1,500.00 |
| TOTAL MONTHLY ESTIMATE | R$ 49,000.00 | |||
| TOTAL ANNUAL ESTIMATE (12 months) | R$ 588,000.00 | |||
4.1 Validity: This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After the expiration date, prices and availability of the Doctor General Practitioner services may be subject to revision.
4.2 Payment Terms: Payment shall be made via bank transfer (TED/PIX) to the account designated by the service provider. Invoices will be issued on the 5th business day of each month for the preceding month's services. A 2% discount applies to payments settled within five (5) business days of the invoice date.
4.3 Contract Duration: The engagement for Doctor General Practitioner services shall be for an initial period of twelve (12) months, renewable by mutual written agreement. Either party may terminate the contract with a sixty (60) day written notice.
4.4 Service Location: All in-person consultations and on-site visits will take place within the administrative boundaries of Brasília, Distrito Federal, Brazil. Travel to locations outside the Plano Piloto (e.g., Taguatinga, Ceilândia, Gama) will incur an additional travel surcharge of R$ 150.00 per visit.
4.5 Confidentiality: The Doctor General Practitioner and all associated staff are bound by strict medical confidentiality in accordance with the Brazilian General Data Protection Law (LGPD – Lei Geral de Proteção de Dados, Law No. 13.709/2018) and the CFM Code of Medical Ethics.
4.6 Cancellation and No-Show Policy: Appointments cancelled less than 24 hours in advance will be subject to a 50% fee of the scheduled consultation. No-shows will be charged in full.
4.7 Force Majeure: Neither party shall be liable for failure to perform obligations due to events beyond reasonable control, including but not limited to public health emergencies, natural disasters, or government-mandated closures within Brasília.
5. Acceptance and AuthorizationBy signing below, the client acknowledges receipt of this Quotation Estimate and agrees to the terms, conditions, and pricing outlined herein for the engagement of the Doctor General Practitioner services in Brazil Brasília.
Service ProviderDr. Ricardo Almeida – CRM-DF 45.821
Doctor General Practitioner
Date: _______________ Client / Authorized Representative
Empresa de Saúde Corporativa Ltda.
Name: _________________________
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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