Quotation Estimate Doctor General Practitioner in Uganda Kampala –Free Word Template Download with AI
Plot 14, Kampala Road, Kampala, Uganda
Tel: +256 772 345 678 | Email: [email protected]
Uganda Medical Council Registration No: UMC/2019/04521
Quotation Estimate| Quotation Estimate No.: | KGP/QE/2025/00347 |
| Date of Issue: | 12 June 2025 |
| Valid Until: | 12 July 2025 (30 days) |
| Prepared For: | Mrs. Aisha Nakato – Personal Health Care Plan |
| Prepared By: | Dr. Samuel Okello, Doctor General Practitioner |
| Location of Service: | Kampala General Medical Practice, Kampala, Uganda |
| Currency: | Ugandan Shillings (UGX) |
This Quotation Estimate is issued by Dr. Samuel Okello, a licensed Doctor General Practitioner operating at the Kampala General Medical Practice in Uganda Kampala, to provide a comprehensive and transparent breakdown of all anticipated medical services, consultations, diagnostic procedures, and follow-up care required for the patient named above. This document serves as a formal Quotation Estimate for the full twelve-month primary healthcare engagement and is intended to allow the patient and any associated health insurance provider to review, approve, and budget for the recommended course of care within the Uganda Kampala healthcare system.
As a Doctor General Practitioner registered with the Uganda Medical and Dental Council, Dr. Okello provides first-line, comprehensive medical care to residents of Uganda Kampala and surrounding districts. The services outlined in this Quotation Estimate reflect standard clinical protocols, current fee schedules as approved by the Uganda Medical Association, and the specific health needs identified during the initial assessment conducted on 5 June 2025.
2. Itemized Services and Costs| No. | Service Description | Frequency | Unit Cost (UGX) | Total (UGX) | Notes |
|---|---|---|---|---|---|
| 1 | Comprehensive Consultation with Doctor General Practitioner (initial and follow-up visits) | Monthly (12 visits) | 150,000 | 1,800,000 | Includes history review, physical examination, and clinical advice |
| 2 | Full Blood Count (FBC) and Complete Metabolic Panel | Quarterly (4 tests) | 85,000 | 340,000 | Performed at accredited Kampala laboratory |
| 3 | Blood Pressure Monitoring and Cardiovascular Risk Assessment | Monthly (12 sessions) | 50,000 | 600,000 | Includes ECG screening twice per year |
| 4 | Diabetes Screening (HbA1c) and Lipid Profile | Bi-annually (2 tests) | 120,000 | 240,000 | Recommended for patients over 40 in Uganda Kampala |
| 5 | Prescription Medications (chronic management – antihypertensives, statins) | Monthly (12 refills) | 95,000 | 1,140,000 | Subject to dosage adjustments by the Doctor General Practitioner |
| 6 | Health Education and Lifestyle Counselling Session | Quarterly (4 sessions) | 75,000 | 300,000 | Nutrition, exercise, and stress management guidance |
| 7 | Urgent / After-Hours Consultation (Doctor General Practitioner on-call) | As needed (est. 2 visits) | 250,000 | 500,000 | Available 7 days a week in Uganda Kampala |
| 8 | Referral Coordination and Specialist Liaison (if required) | As needed (est. 1 referral) | 100,000 | 100,000 | Administrative coordination only; specialist fees separate |
| 9 | Annual Comprehensive Health Check-Up (full physical, imaging, and lab work) | Once (12 months) | 450,000 | 450,000 | Includes chest X-ray, abdominal ultrasound, and urinalysis |
| TOTAL ESTIMATED ANNUAL COST | UGX 5,470,000 | ||||
- This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiry date, all fees are subject to revision in accordance with the prevailing rates set by the Uganda Medical Association for the Uganda Kampala region.
- Payment may be made in full upon acceptance of this Quotation Estimate, or in monthly instalments of UGX 455,833 (approximately) over twelve (12) months. A 10% administrative surcharge applies to instalment plans.
- All payments are to be made in Ugandan Shillings (UGX) via bank transfer to Kampala General Medical Practice, Account No. 0045-8821-3377, Stanbic Bank, Kampala Branch, or by mobile money (MTN/Airtel) to the registered clinic number.
- Any services not explicitly listed in this Quotation Estimate, including emergency hospitalisation, surgical procedures, or specialist consultations beyond the scope of the Doctor General Practitioner, will be quoted separately and require prior written approval from the patient.
- The Doctor General Practitioner reserves the right to adjust the treatment plan and, consequently, the costs outlined herein, should the patient's clinical condition change during the engagement period. Any such adjustments will be communicated in writing and a revised Quotation Estimate will be issued.
- This Quotation Estimate does not constitute a guarantee of specific medical outcomes. All care is provided in accordance with the standards of practice established by the Uganda Medical and Dental Council and the ethical guidelines of the Uganda Medical Association.
- Confidentiality of all patient records and the terms of this Quotation Estimate is guaranteed under the Uganda Data Protection and Privacy Act, 2019.
- Disputes arising from this Quotation Estimate shall be resolved through mediation in Uganda Kampala in accordance with the laws of the Republic of Uganda.
By signing below, the patient acknowledges receipt of this Quotation Estimate, confirms understanding of the services to be provided by the Doctor General Practitioner in Uganda Kampala, and authorises the commencement of the outlined healthcare plan upon the first payment.
Dr. Samuel OkelloDoctor General Practitioner
Kampala General Medical Practice
Date: _______________ Patient / Authorised Representative
Name: Mrs. Aisha Nakato
Signature: _______________
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
Create your own Word template with our GoGPT AI prompt:
GoGPT