Quotation Estimate Radiologist in Chile Santiago –Free Word Template Download with AI
Professional Radiologist Services
Santiago, Chile
1. Provider InformationRadiology Practice
Dr. Carolina Fuentes Mardones
Radiologist – R.M. N° 148.732
Centro de Diagnóstico por Imagen Andes
Av. Apoquindo 4560, Piso 3
Las Condes, Santiago, Chile
Phone: +56 2 2345 6789
Email: [email protected]
RUT: 12.345.678-9
Client / Requesting Party
Clínica Santa María del Bosque
Department of Internal Medicine
Av. Concha y Toro 300
Providencia, Santiago, Chile
RUT: 76.543.210-K
Contact: Dr. Rodrigo Salazar
Phone: +56 2 2987 6543
Email: [email protected]
This Quotation Estimate is issued by Dr. Carolina Fuentes Mardones, a certified Radiologist registered with the Colegio Médico de Chile, to provide comprehensive diagnostic imaging interpretation services to Clínica Santa María del Bosque, located in the metropolitan area of Santiago, Chile. The services described below comply with the regulations established by the Superintendencia de Salud de Chile and the standards set forth by the Colegio de Médicos de Chile regarding radiological practice in the Santiago metropolitan region.
The Radiologist will be available on a contractual basis to perform image reading, diagnostic reporting, and clinical consultation for the referring physicians of the client institution. All services will be rendered in accordance with the professional standards applicable in Chile Santiago and the broader national healthcare framework.
3. Itemized Cost Breakdown| # | Service Description | Quantity | Unit Price (CLP) | Subtotal (CLP) | Frequency |
|---|---|---|---|---|---|
| 1 | Interpretation and written diagnostic report of X-ray studies (chest, abdomen, extremities, spine) – per study | 120 | 45.000 | 5.400.000 | Monthly |
| 2 | Interpretation and written diagnostic report of Computed Tomography (CT) scans – per study | 80 | 95.000 | 7.600.000 | Monthly |
| 3 | Interpretation and written diagnostic report of Magnetic Resonance Imaging (MRI) – per study | 50 | 135.000 | 6.750.000 | Monthly |
| 4 | Interpretation and written diagnostic report of Ultrasound (abdominal, pelvic, obstetric, Doppler) – per study | 100 | 65.000 | 6.500.000 | Monthly |
| 5 | Urgent / on-call Radiologist consultation for emergency imaging interpretation (24/7 coverage, Santiago metropolitan area) | 16 | 180.000 | 2.880.000 | Monthly |
| 6 | Second opinion / peer review of complex or indeterminate imaging studies | 15 | 110.000 | 1.650.000 | Monthly |
| 7 | Monthly multidisciplinary tumor board participation and radiology case presentation | 4 | 150.000 | 600.000 | Monthly |
| 8 | Administrative coordination, PACS integration support, and quality assurance reporting | 1 | 350.000 | 350.000 | Monthly |
| TOTAL MONTHLY ESTIMATE (CLP) | 31.730.000 | — | |||
| ANNUALIZED ESTIMATE (12 months, CLP) | 380.760.000 | — | |||
- This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiration date, pricing may be subject to revision based on current market conditions in Santiago, Chile.
- All prices are expressed in Chilean Pesos (CLP) and are exclusive of the applicable Value Added Tax (IVA) of 19%, which will be added to the final invoice in accordance with the regulations of the Servicio de Impuestos Internos (SII) of Chile.
- The Radiologist shall deliver all diagnostic reports within a maximum of four (4) hours for routine studies and within one (1) hour for urgent or emergency studies, in compliance with the service-level expectations of the Santiago metropolitan healthcare network.
- Payment terms: Net 30 days from the date of invoice issuance. Payment shall be made via electronic bank transfer to the account designated by the provider. Late payments shall accrue interest at the rate established by the Banco Central de Chile.
- The contractual period shall be for an initial term of twelve (12) months, renewable by mutual written agreement. Either party may terminate the agreement with a sixty (60) day prior written notice.
- All diagnostic reports and patient imaging data shall be handled in strict compliance with Chilean Law N° 19.628 on the Protection of Private Life (Ley de Protección de la Vida Privada) and the data protection regulations applicable in Chile Santiago.
- The Radiologist maintains professional liability insurance (seguro de responsabilidad civil profesional) with a coverage of no less than CLP 500.000.000, as required by the Colegio Médico de Chile for practitioners operating in the Santiago region.
- Any modification to the scope of services, volume of studies, or coverage hours must be agreed upon in writing and will be reflected in a supplementary Quotation Estimate or contract addendum.
- This Quotation Estimate does not constitute a binding contract until both parties have executed the definitive service agreement. It serves solely as a good-faith estimate of professional Radiologist fees for the services described herein.
- Disputes arising from this Quotation Estimate or the subsequent contract shall be resolved under the jurisdiction of the competent courts of Santiago, Chile, in accordance with the Chilean Civil Code and applicable commercial legislation.
By signing below, both parties acknowledge that they have reviewed and understood the terms of this Quotation Estimate for Radiologist services to be provided in Santiago, Chile. This document represents a non-binding estimate and does not obligate either party to enter into a contractual relationship until a formal agreement is executed.
Dr. Carolina Fuentes Mardones
Radiologist – Provider
R.M. N° 148.732
Santiago, Chile
Date: _______________
Dr. Rodrigo Salazar
Director of Procurement
Clínica Santa María del Bosque
Santiago, Chile
Date: _______________
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