Quotation Estimate Radiologist in Belgium Brussels –Free Word Template Download with AI

PARTIES INVOLVED

Prepared For (Client)

Hôpital Universitaire Saint-Luc

Chaussée de Charleroi 537

1040 Brussels, Belgium

Contact: Dr. Marie Van den Broeck

Department of Diagnostic Imaging

Prepared By (Provider)

Dr. James Okafor, MD, PhD

Consultant Radiologist

Brussels Medical Imaging Centre

Belgian Medical Council Reg. No: 2019-4478-BR

Specialty: Diagnostic & Interventional Radiology

SCOPE OF SERVICES – RADIOLOGIST CONSULTATION & IMAGING

This Quotation Estimate is issued by Dr. James Okafor, a certified Radiologist practising in Belgium Brussels, in response to the formal request submitted by Hôpital Universitaire Saint-Luc for the provision of specialist radiological services. The scope of work outlined below encompasses the full range of diagnostic imaging interpretation, clinical consultation, and interventional procedures that the Radiologist will deliver to the client institution within the Brussels metropolitan area. All services are performed in strict compliance with the Belgian Federal Law on Medical Practice (Loi du 22 décembre 2013) and the RIZIV/INAMI reimbursement framework applicable in Belgium Brussels.

ITEMISED COST BREAKDOWN

Ref	Description of Service	Quantity	Unit Rate (EUR)	Subtotal (EUR)	VAT (21%)
01	Consultation and interpretation of MRI scans (brain, spine, abdomen) – per study	120	€ 185.00	€ 22,200.00	€ 4,662.00
02	CT scan interpretation (chest, abdomen, pelvis, angiography) – per study	200	€ 145.00	€ 29,000.00	€ 6,090.00
03	Ultrasound examination and real-time reporting (abdominal, obstetric, vascular) – per session	150	€ 110.00	€ 16,500.00	€ 3,465.00
04	Interventional radiology procedures (biopsies, embolisation, drainage) – per procedure	35	€ 850.00	€ 29,750.00	€ 6,247.50
05	Emergency radiology on-call coverage (24/7, 365 days) – per month	12	€ 3,200.00	€ 38,400.00	€ 8,064.00
06	Multidisciplinary tumour board participation and second-opinion consultations – per session	48	€ 220.00	€ 10,560.00	€ 2,217.60
07	Training and supervision of resident radiologists and radiography technicians – per day	60	€ 450.00	€ 27,000.00	€ 5,670.00
08	Written radiology reports in French and English, including structured PACS integration – per report	500	€ 35.00	€ 17,500.00	€ 3,675.00
TOTAL (excl. VAT)				€ 190,910.00	€ 40,091.10
GRAND TOTAL (incl. 21% VAT)				€ 231,001.10

Note: This Quotation Estimate is based on the projected patient volume for the 2025–2026 contract year. Should the actual number of examinations or procedures deviate by more than 15% from the quantities listed above, the Radiologist reserves the right to issue a revised Quotation Estimate within 10 business days. All rates are exclusive of travel expenses incurred outside the Brussels-Capital Region. TERMS AND CONDITIONS

1. Validity: This Quotation Estimate remains valid for a period of thirty (30) calendar days from the date of issue. After this period, the Radiologist may adjust pricing to reflect current market conditions in Belgium Brussels.

2. Payment Terms: Invoices shall be issued on a monthly basis and are payable within thirty (30) days of the invoice date via bank transfer to the IBAN specified in the header. A late-payment interest of 1.5% per month shall apply in accordance with Belgian commercial law.

3. Professional Liability: The Radiologist maintains a professional indemnity insurance policy with a minimum coverage of € 5,000,000 per claim, as required by the Belgian Medical Council. A certificate of insurance shall be provided upon request.

4. Data Protection: All patient data processed under this engagement shall be handled in full compliance with the EU General Data Protection Regulation (GDPR) and the Belgian Royal Decree of 30 July 2001 on medical data. The Radiologist shall not transfer any patient information outside the European Economic Area.

5. Termination: Either party may terminate the service agreement with a written notice of ninety (90) days. In the event of early termination, the client shall be liable for all services rendered up to the effective date of termination.

6. Governing Law: This Quotation Estimate and any resulting contract shall be governed by the laws of the Kingdom of Belgium. Any disputes shall be submitted to the competent courts of Brussels, Belgium.

7. RIZIV/INAMI Reimbursement: Where applicable, the Radiologist shall issue RIZIV-compatible billing codes to facilitate reimbursement for the patient. The client institution is responsible for any co-payment or non-reimbursable portions as defined by the Belgian National Health Insurance Fund.

ACCEPTANCE AND SIGNATURE

By signing below, both parties acknowledge that this Quotation Estimate accurately reflects the agreed-upon scope of Radiologist services to be delivered in Belgium Brussels. This document does not constitute a binding contract until countersigned by both parties and a formal service agreement is executed.

For the Provider (Radiologist):

Dr. James Okafor, MD, PhD

Consultant Radiologist

Signature: ___________________________

Date: ___________________________

For the Client (Institution):

Dr. Marie Van den Broeck

Head of Diagnostic Imaging

Hôpital Universitaire Saint-Luc, Brussels

Signature: ___________________________

Date: ___________________________

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