Quotation Estimate Doctor General Practitioner in Russia Saint Petersburg –Free Word Template Download with AI
Professional Medical Services — Doctor General Practitioner
Russia Saint Petersburg — Medical Services Division
1. Provider Information| Organization: | Neva Medical Group, Doctor General Practitioner Services |
| Address: | 12 Nevsky Prospekt, Saint Petersburg, 191011, Russia |
| Registration No.: | INN 7805432109 / OGRN 1157800123456 |
| Contact: | +7 (812) 555-0147 | [email protected] |
| License: | Medical Activity License LO-78-01-0034567, issued by the Federal Service for Surveillance in Healthcare (Rospotrebnadzor), Russia Saint Petersburg region |
| Client Name: | _____________________________ (To be completed upon acceptance) |
| Client Address: | _____________________________, Saint Petersburg, Russia |
| Contact Person: | _____________________________ | Tel: _____________________________ |
| Insurance / Payer: | _____________________________ (if applicable) |
This Quotation Estimate outlines the comprehensive range of primary care services to be delivered by a certified Doctor General Practitioner operating within the jurisdiction of Russia Saint Petersburg. The Doctor General Practitioner will provide full-spectrum outpatient medical care in accordance with the Federal Law of the Russian Federation No. 323-FZ "On the Fundamentals of Health Protection of Citizens in the Russian Federation" and all applicable regional regulations of the Saint Petersburg municipality.
Note: All services described in this Quotation Estimate are subject to the availability of the assigned Doctor General Practitioner and compliance with the current medical protocols established by the Ministry of Health of the Russian Federation for the Saint Petersburg region. 4. Itemized Cost Breakdown| Item No. | Service Description | Frequency / Qty | Unit Price (RUB) | Total (RUB) |
|---|---|---|---|---|
| 1 | Initial comprehensive consultation with Doctor General Practitioner (history, physical examination, preliminary diagnosis) | 1 session | 3,500 | 3,500 |
| 2 | Follow-up consultation with Doctor General Practitioner (treatment plan review, medication adjustment) | 4 sessions | 2,800 | 11,200 |
| 3 | Annual preventive health check-up (blood work, ECG, urinalysis, abdominal ultrasound, chest X-ray) performed under Doctor General Practitioner supervision | 1 package | 8,900 | 8,900 |
| 4 | Home visit by Doctor General Practitioner within Saint Petersburg city limits (up to 15 km from Nevsky Prospekt) | 2 visits | 5,200 | 10,400 |
| 5 | Telemedicine consultation with Doctor General Practitioner (video call, electronic prescription issuance) | 6 sessions | 1,800 | 10,800 |
| 6 | Issuance of medical certificates, sick leave documents, and referral letters by Doctor General Practitioner | 3 documents | 1,200 | 3,600 |
| 7 | Chronic disease management program (diabetes, hypertension, asthma) coordinated by Doctor General Practitioner | 12 months | 4,500 | 54,000 |
| 8 | Urgent after-hours consultation with Doctor General Practitioner (weekends and public holidays in Russia Saint Petersburg) | 2 sessions | 4,000 | 8,000 |
| SUBTOTAL | 110,400 | |||
| VAT (20% — Russian Federation standard rate) | 22,080 | |||
| GRAND TOTAL (RUB) | 132,480 | |||
- This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiry date, all prices listed herein are subject to revision based on current market conditions in Russia Saint Petersburg and any changes in federal or municipal healthcare pricing regulations.
- The Doctor General Practitioner assigned to this engagement holds a valid specialist certificate in General Practice (Therapy) issued by the Ministry of Health of the Russian Federation and maintains continuous professional development as required by the National Medical Chamber of Russia.
- All medical services will be rendered at the Neva Medical Group facility located at 12 Nevsky Prospekt, Saint Petersburg, Russia, or at the client's residence within the defined city boundaries, unless otherwise agreed in writing.
- Payment is due within fifteen (15) business days of the acceptance of this Quotation Estimate. Payment may be made via bank transfer to the account of Neva Medical Group, OOO, or by cash at the Saint Petersburg reception office. A receipt conforming to Russian Federal Tax Service requirements will be issued for every transaction.
- The Doctor General Practitioner is bound by the professional medical confidentiality code established under Article 13 of Federal Law No. 323-FZ. All patient records and medical data will be stored in compliance with Federal Law No. 152-FZ "On Personal Data" applicable in Russia Saint Petersburg.
- Any additional diagnostic procedures, specialist referrals, or pharmaceutical prescriptions beyond the scope defined in Section 4 of this Quotation Estimate will be quoted separately and require prior written approval from the client.
- In the event of force majeure, including but not limited to public health emergencies declared by the Government of the Russian Federation, the Doctor General Practitioner may transition services to a telemedicine format without additional charge, provided clinical safety is maintained.
- This Quotation Estimate does not constitute a binding contract until countersigned by both parties. Upon acceptance, a formal Service Agreement will be executed in duplicate, with one copy retained by each party in accordance with Russian civil law.
- All disputes arising from the interpretation or execution of this Quotation Estimate shall be resolved through negotiation, and failing that, through the Arbitration Court of Saint Petersburg, Russia, in accordance with the applicable procedural rules.
By signing below, the client acknowledges receipt of this Quotation Estimate and agrees to the terms outlined for the engagement of a Doctor General Practitioner in Russia Saint Petersburg. The provider confirms that all listed services will be delivered in full compliance with the standards of the Saint Petersburg Department of Health.
For the Provider:
Neva Medical Group, OOO
Name: ___________________________Title: Chief Medical Officer
Signature: _________________________
Date: _____________________________
For the Client:
Authorized Representative
Name: ___________________________Title: ___________________________
Signature: _________________________
Date: _____________________________ ⬇️ Download as DOCX Edit online as DOCX
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