Quotation Estimate Radiologist in Indonesia Jakarta –Free Word Template Download with AI
Provider Information
PT Medis Radiologi Nusantara
Jl. Jend. Sudirman Kav. 52-53, SCBD
Jakarta Selatan 12190, Indonesia Jakarta
Tel: +62 21 5790 1234
Email: [email protected]
NPWP: 01.234.567.8-051.000
Client Information
PT Sehat Medika Hospital
Jl. Gatot Subroto No. 88
Jakarta Pusat 10270, Indonesia Jakarta
Attn: Dr. Hendra Wijaya, Chief of Radiology
Tel: +62 21 7200 5678
Email: [email protected]
This Quotation Estimate is prepared by PT Medis Radiologi Nusantara to provide comprehensive Radiologist diagnostic imaging and interpretation services for PT Sehat Medika Hospital, located in Indonesia Jakarta. The scope encompasses the provision of board-certified Radiologist professionals who will perform, supervise, and interpret all diagnostic imaging modalities including but not limited to X-ray, Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Ultrasound, and Mammography. All Radiologist personnel assigned under this Quotation Estimate shall hold valid registration with the Indonesian Medical Council (Konsil Kedokteran Indonesia) and the Indonesian Radiology Society (PERSI), ensuring full compliance with national healthcare regulations in Indonesia Jakarta.
| No. | Service Description | Duration | Quantity | Unit Price (IDR) | Subtotal (IDR) |
|---|---|---|---|---|---|
| 1 | Senior Radiologist – CT & MRI Interpretation (Full-time, 5 days/week) | 12 months | 2 persons | 45,000,000 | 1,080,000,000 |
| 2 | Mid-level Radiologist – X-ray & Ultrasound (Full-time, 5 days/week) | 12 months | 3 persons | 32,000,000 | 1,152,000,000 |
| 3 | Interventional Radiologist – Specialized Procedures (On-call, 24/7 coverage) | 12 months | 1 person | 55,000,000 | 660,000,000 |
| 4 | Emergency Radiologist – Night & Weekend Shifts (Indonesia Jakarta site) | 12 months | 2 persons | 38,000,000 | 912,000,000 |
| 5 | Radiologist Supervision & Quality Assurance Program | 12 months | 1 package | 85,000,000 | 85,000,000 |
| 6 | Continuing Medical Education & PERSI Certification Support | 12 months | 8 persons | 5,000,000 | 40,000,000 |
| 7 | Remote Teleradiology Service – Secondary Read (Indonesia Jakarta network) | 12 months | 1 package | 120,000,000 | 120,000,000 |
| Subtotal: | IDR 4,049,000,000 |
| VAT (PPN) 11%: | IDR 445,390,000 |
| Withholding Tax (PPh 23) 2%: | (IDR 80,980,000) |
| Grand Total (Net): | IDR 4,413,410,000 |
- This Quotation Estimate is valid for a period of thirty (30) calendar days from the date of issue. Any acceptance beyond this period requires revalidation of all pricing and Radiologist availability.
- All Radiologist professionals engaged under this Quotation Estimate shall be based in or regularly commute to the Indonesia Jakarta service area. Travel and accommodation costs for out-of-Jakarta assignments are excluded unless separately agreed in writing.
- Payment terms: 50% advance payment upon contract signing, with the remaining 50% payable in two equal monthly installments. All payments shall be made via bank transfer to the account designated by PT Medis Radiologi Nusantara.
- The Radiologist personnel assigned shall comply with all Indonesian healthcare regulations, including those issued by the Ministry of Health of the Republic of Indonesia (Kementerian Kesehatan RI) and the Indonesian Medical Council operating in Indonesia Jakarta.
- Any additional Radiologist services, extended shifts, or specialized procedures not covered in this Quotation Estimate shall be subject to a supplementary quotation at the prevailing rates.
- This Quotation Estimate does not constitute a binding contract until formally accepted in writing by both parties and converted into a Service Agreement.
- All diagnostic reports produced by the Radiologist team shall be delivered within the standard turnaround time of four (4) hours for routine studies and one (1) hour for emergency cases, as per Indonesia Jakarta hospital protocols.
- Confidentiality of all patient data and imaging records is strictly maintained in accordance with Indonesian Law No. 36 of 2009 on Health and applicable data protection regulations.
Prepared By (Provider)
Dr. Sari Kusuma, Sp.Rad(K)Director, PT Medis Radiologi Nusantara
Date: _______________
Accepted By (Client)
Dr. Hendra Wijaya, Sp.RadChief of Radiology, PT Sehat Medika Hospital
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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