Quotation Estimate Nurse in United States Chicago –Free Word Template Download with AI
Professional Healthcare Staffing & Nurse Placement Services
1400 N. Lake Shore Drive, Suite 850, Chicago, IL 60610, United States
Phone: (312) 555-0147 | Email: [email protected]
IL License No. 2024-NRS-88471 | NPI: 1740298356
Quotation EstimateQuotation Details
Quotation Estimate No.: QTE-2025-CHIC-00382
Date of Issue: June 12, 2025
Valid Until: July 12, 2025 (30 days)
Service Location: United States Chicago, Illinois
Nurse Services – In-Home & Facility
Prepared For
Client Name: [Client / Facility Name]
Address: [Street Address], Chicago, IL 606XX
Contact Person: [Name & Title]
Phone: [Phone Number]
Email: [Email Address]
Dear Valued Client,
Thank you for your inquiry regarding professional Nurse services in the United States Chicago metropolitan area. This Quotation Estimate has been carefully prepared to outline the scope of nursing services, associated costs, and terms of engagement for your specific requirements. Our team of licensed and experienced Nurse professionals is dedicated to delivering the highest standard of patient care in compliance with all Illinois Department of Public Health regulations and federal healthcare standards applicable in the United States Chicago region.
Scope of Nurse ServicesThis Quotation Estimate covers the provision of a qualified Registered Nurse (RN) or Licensed Practical Nurse (LPN) for the following services to be performed at the client's designated location within the United States Chicago area (including Cook County, DuPage County, and Lake County):
- Comprehensive patient assessment and vital sign monitoring (blood pressure, temperature, pulse, respiration, oxygen saturation)
- Medication administration and management per physician orders
- Wound care, dressing changes, and post-surgical monitoring
- Intravenous (IV) therapy administration and maintenance
- Patient education on disease management, medication adherence, and lifestyle modifications
- Coordination of care with primary care physicians, specialists, and hospital discharge teams
- Documentation of all nursing interventions in the patient's electronic health record (EHR)
- Emergency response protocols and escalation procedures per Illinois nursing practice act
| # | Service Description | Duration / Frequency | Rate | Estimated Cost (USD) |
|---|---|---|---|---|
| 1 | Registered Nurse (RN) – In-Home Care (4-hour shifts, 5 days/week) | 20 hrs/week × 4 weeks | $78.50/hr | $6,280.00 |
| 2 | Licensed Practical Nurse (LPN) – Supplemental Care (2-hour shifts, 3 days/week) | 6 hrs/week × 4 weeks | $52.00/hr | $1,248.00 |
| 3 | Initial Comprehensive Nursing Assessment & Care Plan Development | One-time (3 hrs) | $95.00/hr | $285.00 |
| 4 | Specialized Wound Care & IV Therapy (as needed, estimated 4 sessions) | 4 sessions × 1.5 hrs | $85.00/hr | $510.00 |
| 5 | Travel & Transportation within United States Chicago Metro Area | Per shift (estimated) | Flat rate | $320.00 |
| 6 | Medical Supplies & Consumables (gloves, dressings, IV kits, syringes) | Monthly provision | Flat rate | $450.00 |
| 7 | Administrative & Documentation Fees (EHR entry, insurance billing support) | Monthly | Flat rate | $200.00 |
| 8 | 24/7 On-Call Nurse Availability & Emergency Response (Chicago area) | Monthly retainer | Flat rate | $350.00 |
| Subtotal (4-Week Period) | $9,643.00 | |||
| Applicable Illinois Sales Tax (10.25%) | $988.41 | |||
| TOTAL ESTIMATED COST (USD) | $10,631.41 | |||
- This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiration date, rates may be subject to revision based on market conditions in the United States Chicago healthcare staffing sector.
- All Nurse personnel assigned under this agreement hold active Illinois nursing licenses (RN or LPN) issued by the Illinois Department of Financial and Professional Regulation (IDFPR) and maintain current BLS/ACLS certifications through the American Heart Association.
- Payment terms: 50% deposit due upon acceptance of this Quotation Estimate; remaining 50% due within fifteen (15) business days of service completion. Late payments incur a 1.5% monthly interest charge per Illinois commercial code.
- Client is responsible for providing a safe, accessible environment for the Nurse to perform duties. Any hazardous conditions must be disclosed prior to service commencement.
- Services are subject to the Illinois Nursing Practice Act (225 ILCS 65) and all applicable federal regulations including HIPAA privacy and security standards.
- Cancellation policy: Cancellations with more than 48 hours' notice incur no charge. Cancellations within 48 hours are subject to a 50% fee of the scheduled shift value.
- All Nurse services are covered by our professional liability insurance (minimum $2,000,000 per occurrence) and workers' compensation as required by the State of Illinois.
- This Quotation Estimate does not constitute a binding contract until countersigned by both parties. A formal Service Agreement will be executed upon acceptance.
- Any changes to the scope of Nurse services, frequency, or location within the United States Chicago area must be communicated in writing and may result in a revised Quotation Estimate.
By signing below, the client acknowledges receipt of this Quotation Estimate for Nurse services in United States Chicago and agrees to the terms and conditions outlined herein.
Client SignatureName / Title / Date Authorized Representative – Midwest Care Solutions, LLC
Name / Title / Date ⬇️ Download as DOCX Edit online as DOCX
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