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Quotation Estimate Radiologist in Italy Naples –Free Word Template Download with AI

Professional Radiologist Diagnostic Imaging Services

Naples, Campania, Italy

Quotation Estimate No.:

QE-NAP-2025-0487

Date of Issue:

14 June 2025

Valid Until:

14 September 2025

Prepared By:

Dr. Maria Concetta Ferrante, MD, PhD

Board-Certified Radiologist

Clinica Radiologica del Golfo

Via Toledo 142, 80132 Naples, Italy

Tel: +39 081 555 0192

Email: [email protected]

CLIENT INFORMATION
Field Details
Client / Referring Physician: Dr. Alessandro Romano, MD – Department of Internal Medicine, Ospedale del Mare, Via Antonio De Crecenzo snc, 80147 Naples, Italy
Patient Name: Confidential – Refer to Medical Record No. OM-2025-3341
Referral Reason: Comprehensive diagnostic imaging evaluation including multi-contrast MRI of the lumbar spine, CT angiography of the thoracic aorta, and targeted ultrasound of the abdominal region, as part of a routine annual health screening programme for a patient residing in the Naples metropolitan area.
SCOPE OF SERVICES – RADIOLIST CONSULTATION AND DIAGNOSTIC IMAGING

This Quotation Estimate is issued by Dr. Maria Concetta Ferrante, a senior Radiologist practising in Italy Naples, to outline the full scope of diagnostic imaging services, professional interpretation, and associated clinical consultations to be provided. All procedures will be conducted in strict compliance with the Italian Ministry of Health regulations (Ministero della Salute), the European Union Medical Devices Regulation (EU) 2017/745, and the professional standards set forth by the Italian Society of Medical Radiology (SIRM – Società Italiana di Radiologia Medica).

The Radiologist will personally supervise all imaging acquisitions, perform the primary and secondary reading of every study, and deliver a comprehensive written diagnostic report within 48 hours of the final procedure. In the event of a critical or urgent finding, the Radiologist will communicate the result directly to the referring physician by telephone within two hours of image acquisition.

ITEMISED COST BREAKDOWN
No. Service / Procedure Modality / Duration Unit Cost (EUR) Quantity Subtotal (EUR)
1 Initial consultation with the Radiologist – clinical history review, physical assessment, and imaging protocol planning Face-to-face, 30 min € 120.00 1 € 120.00
2 MRI Lumbar Spine (L1–S1) with and without intravenous gadolinium contrast – 3T scanner, full multiplanar sequences including T1, T2, STIR, and post-contrast T1 fat-saturated 3T MRI, approx. 45 min € 480.00 1 € 480.00
3 CT Angiography of the Thoracic Aorta – 128-slice multidetector CT, arterial and venous phase acquisition, 3D volume-rendered reconstruction MDCT, approx. 20 min € 520.00 1 € 520.00
4 Targeted Abdominal Ultrasound – liver, gallbladder, pancreas, spleen, kidneys, and aorta with Doppler flow assessment Ultrasound, approx. 30 min € 180.00 1 € 180.00
5 Written diagnostic report by the Radiologist – detailed findings, impressions, and recommendations for each modality, delivered electronically and in hard copy Per study (3 reports) € 65.00 3 € 195.00
6 Follow-up consultation with the Radiologist – review of all imaging results with the patient and/or referring physician, discussion of findings, and recommendations for further management Face-to-face, 30 min € 100.00 1 € 100.00
7 Contrast media (gadolinium-based for MRI, iodinated for CT) and intravenous access materials Per procedure € 85.00 2 € 170.00
8 Image storage and PACS archiving – secure digital storage of all DICOM images for a period of 10 years in compliance with Italian data-protection law (GDPR and D.Lgs. 196/2003) Annual € 45.00 1 € 45.00
Subtotal (before VAT) € 1,810.00
VAT (IVA) – 22% (Italian standard rate for private diagnostic services) € 398.20
TOTAL AMOUNT DUE € 2,208.20
Note: This Quotation Estimate is valid for a period of 90 days from the date of issue. Should the patient require additional imaging sequences, repeat examinations, or an extended consultation with the Radiologist beyond the scope described above, a supplementary Quotation Estimate will be issued prior to any additional procedure. All prices are quoted in Euro (EUR) and are inclusive of all applicable Italian taxes unless otherwise stated. TERMS AND CONDITIONS
  1. This Quotation Estimate is a non-binding offer and does not constitute a contractual obligation until formally accepted in writing by the client or referring physician.
  2. All diagnostic imaging procedures will be performed at the Clinica Radiologica del Golfo, Via Toledo 142, Naples, Italy, or at such other location in the Naples metropolitan area as mutually agreed upon in writing.
  3. The Radiologist reserves the right to modify the imaging protocol if, during the initial consultation, additional sequences or modalities are deemed clinically necessary. Any such modification will be communicated to the client before the procedure and will be reflected in a revised Quotation Estimate.
  4. Payment is due within 30 days of the date of the final diagnostic report. Payment may be made by bank transfer (IBAN: IT60 X054 2811 1000 0001 2345 678), credit card, or cash at the clinic reception. Late payments will incur a statutory interest charge of 1.5% per month as per Italian civil code provisions.
  5. The patient must provide a valid referral from a licensed Italian physician and a completed informed-consent form prior to any imaging procedure. The Radiologist will verify the patient's identity and insurance status (SSN – Servizio Sanitario Nazionale or private health insurance) at the time of the initial consultation.
  6. All medical data, imaging files, and diagnostic reports are subject to the Italian General Data Protection Regulation (GDPR) and the national implementing legislation. The Radiologist and the clinic act as data controllers and will process personal health data solely for the purpose of providing the diagnostic services described in this Quotation Estimate.
  7. In the unlikely event of a contrast-media adverse reaction, the clinic is fully equipped with emergency resuscitation facilities and a dedicated emergency physician on standby. The cost of emergency treatment arising from a contrast reaction is included in the Quotation Estimate at no additional charge to the patient.
  8. This Quotation Estimate is governed by the laws of the Italian Republic. Any disputes arising from or in connection with the services described herein shall be subject to the exclusive jurisdiction of the competent courts of Naples, Italy.
ACCEPTANCE AND SIGNATURES

By signing below, the parties acknowledge that they have read, understood, and agree to the terms, conditions, and cost breakdown set forth in this Quotation Estimate for Radiologist diagnostic imaging services in Italy Naples.

For the Radiologist / Service Provider:

Dr. Maria Concetta Ferrante, MD, PhD

Clinica Radiologica del Golfo

Signature & Date

For the Client / Referring Physician:

Dr. Alessandro Romano, MD

Ospedale del Mare, Naples

Signature & Date

Quotation Estimate No. QE-NAP-2025-0487 | Clinica Radiologica del Golfo | Via Toledo 142, 80132 Naples, Italy | P.IVA: IT01234567890

This document is generated electronically and is valid without a physical stamp. For any queries regarding this Quotation Estimate, please contact the clinic office at +39 081 555 0192 or [email protected].

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