Quotation Estimate Doctor General Practitioner in France Lyon –Free Word Template Download with AI
Doctor General Practitioner Services — France Lyon
Ref: QTE-LYON-2025-0047 | Date: 14 June 2025 | Valid Until: 14 July 2025
| Provider: | Cabinet Médicale du Rhône Doctor General Practitioner — Dr. Claire Fontaine, MD 27 Rue de la République, 69002 Lyon, France Tel: +33 4 78 12 34 56 | Email: [email protected] RPPS No. 10101234567 | SIRET: 842 567 890 00012 |
| Client: | M. Jean-Pierre Moreau 14 Avenue Berthelot, 69003 Lyon, France Tel: +33 6 45 78 90 12 Social Security No. (NIR): 84 05 69 123 456 789 |
| Purpose: | Comprehensive annual medical follow-up and preventive care package for a Doctor General Practitioner consultation programme in France Lyon. |
This Quotation Estimate outlines the full range of medical services to be provided by our Doctor General Practitioner practice located in the heart of France Lyon. The following line items represent the estimated costs for the requested annual care plan. All fees are quoted in Euros (EUR) and are subject to the standard French healthcare reimbursement framework (Sécurité Sociale) and applicable complementary insurance (mutuelle) coverage.
| # | Service Description | Code (CCAM) | Unit Price (EUR) | Qty | Subtotal (EUR) | SS Reimbursement |
|---|---|---|---|---|---|---|
| 1 | Initial comprehensive consultation with the Doctor General Practitioner (30 min) — full medical history review, physical examination, and care plan formulation in France Lyon | CCAM 11000001 | €25.00 | 1 | €25.00 | 70% (SS) |
| 2 | Follow-up consultation (15 min) — monitoring of treatment progress and adjustment of prescriptions | CCAM 11000002 | €25.00 | 4 | €100.00 | 70% (SS) |
| 3 | Full blood panel (NFS, glycémie, bilan lipidique, rénal, hépatique) — performed at the laboratory partner in Lyon 2ème | CCAM 11000003 | €42.00 | 2 | €84.00 | 65% (SS) |
| 4 | Electrocardiogram (ECG) — 12-lead resting ECG with interpretation by the Doctor General Practitioner | CCAM 11000004 | €30.00 | 1 | €30.00 | 70% (SS) |
| 5 | Dermatological screening — full-body skin examination for melanoma and pre-cancerous lesions (annual preventive care in France Lyon) | CCAM 11000005 | €35.00 | 1 | €35.00 | 70% (SS) |
| 6 | Vaccination administration (influenza, Td, pneumococcal) — including vaccine cost and administration fee | CCAM 11000006 | €18.00 | 3 | €54.00 | 100% (SS) |
| 7 | Prescription renewal and medication review — annual review of all ongoing prescriptions by the Doctor General Practitioner | CCAM 11000007 | €15.00 | 1 | €15.00 | 70% (SS) |
| 8 | Telemedicine consultation (15 min) — remote follow-up via secure video platform for minor concerns between in-person visits | CCAM 11000008 | €20.00 | 2 | €40.00 | 70% (SS) |
| 9 | Administrative and record-keeping fee — maintenance of the patient medical file, transmission to Sécurité Sociale, and coordination with specialists in the Lyon metropolitan area | CCAM 11000009 | €10.00 | 1 | €10.00 | Non-reimbursable |
| Subtotal (all services): | €413.00 |
| Estimated Sécurité Sociale reimbursement (approx. 70%): | −€289.10 |
| Estimated Mutuelle (complementary insurance) coverage: | −€85.00 |
| Estimated Patient Out-of-Pocket (Reste à Charge): | €38.90 |
TERMS AND CONDITIONS OF THIS QUOTATION ESTIMATE
- This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After this period, pricing may be adjusted to reflect changes in the French national fee schedule (tarif conventionné) or laboratory cost variations in the France Lyon region.
- All services listed herein will be performed by or under the direct supervision of the named Doctor General Practitioner, Dr. Claire Fontaine, at the practice premises located at 27 Rue de la République, 69002 Lyon, France, unless otherwise agreed in writing.
- The estimated Sécurité Sociale and Mutuelle reimbursement figures are indicative only. Actual reimbursement amounts depend on the client's specific insurance contract, the level of coverage (100% Sante or standard), and any applicable franchise or ticket modérator. The client is advised to verify coverage with their mutuelle provider prior to accepting this estimate.
- Payment of the patient's out-of-pocket portion (reste à charge) is due at the time of each consultation or service delivery. The practice accepts cash, bank card (CB), and the Carte Vitale electronic payment system. No payment is required for the portion covered by Sécurité Sociale, as this is settled directly between the practice and the CPAM du Rhône.
- Appointments must be scheduled a minimum of 48 hours in advance. Cancellations made less than 24 hours before the scheduled visit may incur a no-show fee of €20.00, which is non-reimbursable by any insurance scheme.
- This Quotation Estimate does not constitute a binding contract. It serves as a good-faith projection of expected costs. The final invoice may vary if additional diagnostic tests, specialist referrals, or emergency interventions are deemed medically necessary by the Doctor General Practitioner during the course of care.
- All medical records and data processed in connection with these services are governed by the French Data Protection Act (Loi Informatique et Libertés) and the EU General Data Protection Regulation (GDPR). The practice is registered with the CNIL under reference number 2025-LYON-0047.
- In the event of a dispute regarding the services described in this estimate, the parties agree to seek amicable resolution first. Should this fail, the competent courts of Lyon (Tribunal Judiciaire de Lyon) shall have exclusive jurisdiction.
- This document is issued in the French healthcare regulatory context. All fee codes (CCAM) referenced comply with the current nomenclature published by the Haute Autorité de Santé (HAS) and the Caisse Nationale de l'Assurance Maladie (CNAM).
For the Provider
Dr. Claire Fontaine, MD
Doctor General Practitioner
Cabinet Médicale du Rhône, Lyon, France
Date: _______________
For the Client
M. Jean-Pierre Moreau
Date: _______________
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