Quotation Estimate Doctor General Practitioner in Russia Moscow –Free Word Template Download with AI
Medical Consultation & Primary Care Services
| Quotation Estimate No. | QTE-RM-2025-04871 |
| Date of Issue | 14 June 2025 |
| Valid Until | 14 July 2025 (30 calendar days) |
| Prepared By | Dr. Alexander V. Petrov, Doctor General Practitioner, MD, PhD |
| Practice Address | 12 Tverskaya Street, Building 4, Floor 3, 101000, Russia Moscow, Russian Federation |
| Client / Patient | Mr. / Ms. [Full Name], Passport No. [XXXX-XXXX], Registered in Russia Moscow |
| Contact Telephone | +7 (495) 000-00-00 |
| [email protected] |
1. Purpose of This Quotation Estimate
This Quotation Estimate is issued by the undersigned Doctor General Practitioner to provide a comprehensive, itemized breakdown of all anticipated medical services, diagnostic procedures, and associated costs for the client's primary healthcare needs within the jurisdiction of Russia Moscow. This document serves as a formal financial projection and is not a binding contract until accepted in writing by both parties. All pricing in this Quotation Estimate is denominated in Russian Rubles (RUB) and reflects the current fee schedule of the practice located in central Russia Moscow as of the date of issue.
2. Scope of Services — Doctor General Practitioner
The Doctor General Practitioner engaged under this Quotation Estimate will provide the following primary care services in accordance with the Federal Law of the Russian Federation "On the Fundamentals of Health Protection of Citizens" (No. 323-FZ) and the applicable medical licensing regulations of the Russia Moscow Department of Health:
- Comprehensive initial medical examination and health assessment
- Diagnosis, treatment planning, and ongoing management of acute and chronic conditions
- Prescription of pharmacological therapies and referral to specialist physicians within Russia Moscow
- Preventive health screenings, immunizations, and health education
- Issuance of medical certificates, sick leave documentation, and fitness-for-work assessments
- Follow-up consultations and telemedicine appointments as required
3. Itemized Cost Breakdown
| Item No. | Description of Service | Quantity | Unit Price (RUB) | Total (RUB) |
|---|---|---|---|---|
| 01 | Initial Doctor General Practitioner consultation (60 minutes), including full medical history, physical examination, and preliminary diagnosis | 1 | 4,500 | 4,500 |
| 02 | Follow-up Doctor General Practitioner consultation (30 minutes) for treatment review and adjustment | 4 | 3,200 | 12,800 |
| 03 | Complete blood count (CBC), biochemistry panel, urinalysis, and ECG performed at the Russia Moscow diagnostic laboratory | 1 | 6,800 | 6,800 |
| 04 | Abdominal and thoracic ultrasound examination (Russia Moscow imaging centre) | 1 | 5,500 | 5,500 |
| 05 | Prescription of first-line pharmacological therapy (estimated for 30-day supply, subject to actual dispensing) | 1 | 8,200 | 8,200 |
| 06 | Issuance of medical certificate / sick leave documentation (bolnichny list) as required by Russian labour law | 2 | 800 | 1,600 |
| 07 | Telemedicine follow-up session with Doctor General Practitioner (video consultation, 20 minutes) | 2 | 2,000 | 4,000 |
| 08 | Referral coordination and specialist consultation facilitation within Russia Moscow (up to 2 specialists) | 1 | 3,000 | 3,000 |
| 09 | Annual preventive health check-up package (Doctor General Practitioner, Russia Moscow standard protocol) | 1 | 12,000 | 12,000 |
| 10 | Administrative and record-keeping fees (electronic medical record maintenance, Russia Moscow registry compliance) | 1 | 1,500 | 1,500 |
| SUBTOTAL | 59,900 | |||
| VAT (20% — applicable per Russian tax code) | 11,980 | |||
| GRAND TOTAL | 71,880 | |||
4. 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 the expiry date, all prices are subject to revision based on the prevailing fee schedule of the Doctor General Practitioner practice in Russia Moscow.
- Payment is due within fourteen (14) days of acceptance of this Quotation Estimate. Accepted payment methods include bank transfer to the practice account in Russia Moscow, cash at the reception, and major international credit cards.
- All services rendered by the Doctor General Practitioner are subject to the client's informed consent, which must be documented in the electronic medical record maintained in compliance with Russian data protection legislation (152-FZ).
- The Doctor General Practitioner reserves the right to modify the treatment plan, which may result in additional or reduced costs. Any such changes will be communicated to the client in writing prior to implementation, and a supplementary Quotation Estimate will be issued if the total exceeds the original amount by more than ten percent.
- This Quotation Estimate does not include emergency medical services, inpatient hospitalization, or surgical procedures. Should the Doctor General Practitioner determine that such services are necessary, a separate and detailed Quotation Estimate will be prepared in consultation with the relevant specialist department in Russia Moscow.
- All medical records and documentation generated under this engagement are the property of the practice and are stored in accordance with the retention requirements of the Russia Moscow Department of Health. The client retains the right to access and request copies of their records at any time.
- Disputes arising from this Quotation Estimate shall be resolved in accordance with the civil legislation of the Russian Federation and, if necessary, before the competent court of Russia Moscow.
- The Doctor General Practitioner holds a valid medical licence (No. ЛО-77-01-000000) issued by the Russia Moscow Department of Health and is registered with the relevant professional medical association.
5. Acceptance and Authorization
By signing below, the client acknowledges receipt of this Quotation Estimate and agrees to the terms and conditions set forth herein. The Doctor General Practitioner confirms that all services described will be delivered in full compliance with the standards of medical practice applicable in Russia Moscow.
For the Doctor General Practitioner:
Dr. Alexander V. Petrov, MD, PhD
Signature: _________________________
Date: _________________________
Seal: [Official Practice Seal]
For the Client / Patient:
Name: _________________________
Signature: _________________________
Date: _________________________
Passport No.: _________________________
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