Quotation Estimate Nurse in United States Los Angeles –Free Word Template Download with AI
4520 Wilshire Boulevard, Suite 800, Los Angeles, California 90016, United States
Phone: (213) 555-0142 | Email: [email protected] | CA License #NPL-2024-0887
Quotation EstimateQuotation Details
Quotation No.: QTE-2025-0731-LA
Date Issued: June 15, 2025
Valid Until: July 15, 2025
Service Location: United States Los Angeles, CA
Nurse Services – In-Home & FacilityPrepared For
Client Name: Margaret A. Thompson
Address: 2847 Sunset Blvd, Unit 12B, Los Angeles, CA 90026
Contact: (310) 555-7789
Email: [email protected]
Scope of Services – Nurse Care in United States Los AngelesThis Quotation Estimate is issued by Westside Care Partners, LLC to provide a comprehensive and transparent cost breakdown for professional Nurse services to be delivered within the United States Los Angeles metropolitan area. The Nurse services outlined below are designed to meet the specific healthcare needs of the client as discussed during our initial consultation on June 10, 2025. All Nurse personnel assigned to this engagement hold active California Registered Nurse (RN) or Licensed Practical Nurse (LPN) credentials and are fully insured under our professional liability coverage.
Itemized Quotation Estimate Breakdown| Item # | Description of Nurse Service | Frequency | Duration | Unit Rate | Monthly Total |
|---|---|---|---|---|---|
| 01 | Registered Nurse (RN) – Daily vital signs monitoring, medication administration, and wound care assessment | 5 days/week | 4 hours/day | $68.00/hr | $5,440.00 |
| 02 | Licensed Practical Nurse (LPN) – Assistance with personal hygiene, mobility support, and daily living activities | 7 days/week | 6 hours/day | $42.00/hr | $8,736.00 |
| 03 | Nurse Case Management – Weekly care plan review, physician coordination, and progress documentation | 1 day/week | 2 hours/session | $95.00/hr | $760.00 |
| 04 | Emergency Nurse Response – On-call Nurse availability for urgent medical situations within the United States Los Angeles service zone | 24/7 standby | As needed | $150.00/visit | $600.00 (est.) |
| 05 | Medical Supply & Equipment Coordination – Nurse-supervised procurement of prescribed medical supplies | Monthly | 1 hour | $55.00/hr | $55.00 |
| 06 | Administrative & Compliance Fee – California healthcare regulatory compliance, insurance verification, and record-keeping | Monthly | — | Flat fee | $350.00 |
| Estimated Monthly Total (Before Tax): | $16,041.00 | ||||
| Estimated Quarterly Total (3 Months): | $48,123.00 | ||||
- Validity: This Quotation Estimate for Nurse services in United States Los Angeles 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 and California healthcare cost adjustments.
- Payment Terms: Payment is due on the 1st of each month via ACH transfer, check, or approved credit card. A late payment fee of 1.5% per month will apply to outstanding balances exceeding fifteen (15) days.
- Service Area: All Nurse services will be performed within the United States Los Angeles city limits and its immediate surrounding communities, including Beverly Hills, West Hollywood, Santa Monica, and Culver City. Travel beyond a 15-mile radius from the client's residence will incur an additional mileage charge of $0.85 per mile.
- Nurse Qualifications: All Nurse staff assigned to this engagement will maintain current California Board of Registered Nursing (BRN) licenses, valid BLS/ACLS certifications, and a clean background check as required by California Health and Safety Code Section 1276.10.
- Cancellation Policy: The client may cancel this Nurse service agreement with a minimum of fourteen (14) days written notice. Cancellation within the first thirty days of service will incur a 20% early termination fee on the remaining contracted period.
- Insurance: Westside Care Partners, LLC maintains general liability insurance of $2,000,000 and professional Nurse malpractice coverage of $5,000,000 per occurrence. Certificates of insurance are available upon request.
- Scope Changes: Any modification to the Nurse service plan, including changes in frequency, duration, or level of care, will require a written amendment to this Quotation Estimate and mutual agreement from both parties.
- Governing Law: This Quotation Estimate and the resulting service agreement shall be governed by the laws of the State of California, with jurisdiction in the Superior Court of Los Angeles County, United States.
By signing below, the client acknowledges receipt of this Quotation Estimate for Nurse services in United States Los Angeles and agrees to the terms, conditions, and pricing outlined herein. Upon acceptance, a formal Nurse Service Agreement will be executed within five (5) business days.
Client Signature:
_______________________________
Name: Margaret A. Thompson
Date: _______________
Authorized Representative – Westside Care Partners, LLC
_______________________________
Name: David R. Chen, RN, BSN – Director of Nurse Services
Date: _______________
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