Quotation Estimate Radiologist in Brazil Brasília –Free Word Template Download with AI
Professional Radiologist Diagnostic Imaging Services
Serving the Federal District of Brazil Brasília
Service Provider
Brasília Advanced Radiology Center
Av. W3, Setor Sul, Quadra 02, Bloco A
Brasília – DF, CEP 70304-900, Brazil
CNPJ: 12.345.678/0001-90
CRO-DF: 45.678 | CRM-DF: 12.345
Phone: +55 (61) 3333-4455
Email: [email protected]
Client Information
Client Name: [To be filled]
Organization: [To be filled]
Address: [To be filled]
CNPJ/CPF: [To be filled]
Contact Person: [To be filled]
Phone: [To be filled]
Email: [To be filled]
This Quotation Estimate document has been prepared by Brasília Advanced Radiology Center to provide a comprehensive, transparent, and itemized financial proposal for the engagement of a certified Radiologist to deliver diagnostic imaging interpretation services within the city of Brazil Brasília, Federal District. This estimate covers all professional fees, equipment utilization, administrative overhead, and applicable taxes associated with the radiological services described herein. The Quotation Estimate is issued in accordance with the regulatory standards established by the Conselho Federal de Medicina (CFM) and the Conselho Regional de Medicina do Distrito Federal (CRM-DF), ensuring full compliance with Brazilian healthcare legislation.
The Radiologist engaged under this Quotation Estimate is a board-certified specialist registered with the CRM-DF, possessing a minimum of fifteen (15) years of clinical experience in diagnostic radiology. The professional services to be rendered in Brazil Brasília include, but are not limited to, the following diagnostic imaging modalities and interpretation procedures:
| # | Service / Procedure | Modality | Quantity | Unit Price (BRL) | Subtotal (BRL) |
|---|---|---|---|---|---|
| 1 | Computed Tomography (CT) – Head and Neck, with contrast | CT Scan | 120 | R$ 1.850,00 | R$ 222.000,00 |
| 2 | Magnetic Resonance Imaging (MRI) – Lumbar Spine | MRI | 80 | R$ 2.400,00 | R$ 192.000,00 |
| 3 | Digital Mammography – Bilateral, with tomosynthesis | Mammography | 200 | R$ 950,00 | R$ 190.000,00 |
| 4 | Ultrasound – Abdominal Complete (Doppler) | Ultrasound | 150 | R$ 680,00 | R$ 102.000,00 |
| 5 | Digital X-Ray – Chest, PA and Lateral views | Radiography | 300 | R$ 320,00 | R$ 96.000,00 |
| 6 | Positron Emission Tomography (PET/CT) – Whole Body | PET/CT | 25 | R$ 8.500,00 | R$ 212.500,00 |
| 7 | Written Radiologist Report and Clinical Consultation | Professional Fee | 875 | R$ 180,00 | R$ 157.500,00 |
| 8 | On-site Radiologist Availability – Brasília, DF (8 hrs/day, 5 days/week, 12 months) | Professional Fee | 260 | R$ 1.200,00 | R$ 312.000,00 |
| 9 | Image Storage, PACS System Access, and Digital Delivery | Technology | 1 | R$ 45.000,00 | R$ 45.000,00 |
| 10 | Emergency Radiologist Call-out – 24/7 Coverage (Brasília, DF) | Professional Fee | 1 | R$ 38.000,00 | R$ 38.000,00 |
| SUBTOTAL (BRL) | R$ 1.565.000,00 | ||||
| Applicable Taxes – ISS (Brazil Brasília) 5% + PIS/COFINS 3,65% | R$ 124.677,50 | ||||
| TOTAL ESTIMATED COST (BRL) | R$ 1.689.677,50 | ||||
3.1 Validity: This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. After this period, pricing may be subject to revision due to fluctuations in equipment costs, reagent prices, or regulatory changes within the state of Goiás and the Federal District of Brazil Brasília.
3.2 Payment Terms: Payment shall be made in monthly installments of R$ 140.806,46 over a period of twelve (12) months, due on the 5th business day of each month via bank transfer (TED/DOC) to the account specified in the invoice. A 2% discount shall apply for payments made before the 3rd business day of the month.
3.3 Radiologist Availability: The contracted Radiologist shall be physically present at the Brasília Advanced Radiology Center facility located in the Setor Sul district of Brazil Brasília during standard operating hours (Monday to Friday, 07:00 to 19:00 BRT). Emergency call-out services are available 24 hours a day, 7 days a week, with a guaranteed response time of no more than forty-five (45) minutes within the Brasília metropolitan area.
3.4 Regulatory Compliance: All radiological procedures shall be conducted in strict compliance with the Brazilian National Health Surveillance Agency (ANVISA) regulations, the CFM ethical code, and the specific licensing requirements of the CRM-DF. The Radiologist shall maintain valid professional registration and malpractice insurance coverage throughout the contract period.
3.5 Data Protection: All patient imaging data and clinical reports shall be handled in accordance with the Brazilian General Data Protection Law (LGPD – Lei Geral de Proteção de Dados, Law No. 13.709/2018). Digital records shall be stored on encrypted servers located within the national territory of Brazil.
3.6 Cancellation and Termination: Either party may terminate this agreement with a written notice of sixty (60) days. In the event of early termination by the client, a penalty fee equivalent to 10% of the remaining contract value shall be applied.
3.7 Jurisdiction: This Quotation Estimate and any resulting contractual obligations shall be governed by the laws of the Federative Republic of Brazil. Any disputes shall be resolved in the courts of Brazil Brasília, Federal District, with exclusive jurisdiction.
IMPORTANT NOTE: This Quotation Estimate is a non-binding financial projection prepared for the client's evaluation purposes. Final pricing may be adjusted based on the actual volume of procedures performed, changes in the Radiologist's availability, or modifications to the scope of services. All prices are quoted in Brazilian Reais (BRL) and include the applicable ISS tax levied by the municipality of Brasília, DF. This document does not constitute a formal contract until countersigned by both parties.By signing below, the client acknowledges receipt of this Quotation Estimate for Radiologist services in Brazil Brasília and agrees to the terms, conditions, and pricing outlined herein. This signature authorizes Brasília Advanced Radiology Center to proceed with the engagement of the specified Radiologist professional and the allocation of diagnostic imaging equipment as described in Section 2.
Service ProviderBrasília Advanced Radiology Center
Name: Dr. Ricardo Almeida Santos
CRM-DF: 12.345 | CRO-DF: 45.678
Date: _______________ Client / Authorized Representative
Name: _________________________________
Position: ______________________________
CNPJ/CPF: _____________________________
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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