Quotation Estimate Surgeon in Colombia Medellín –Free Word Template Download with AI
Medellín Surgical Excellence Center
Calle 43A # 43D-120, El Poblado, Colombia Medellín, Antioquia
Phone: +57 (604) 444 5566 | Email: [email protected]
NIT: 901.234.567-8 | RUT Verified by DIAN, Colombia
| Client Name: Mr. James R. Thompson | Passport / ID No.: US-44782910 |
| Country of Origin: United States of America | Referring Physician: Dr. Alan Whitfield, MD |
| Procedure Requested: Elective Orthopedic Surgeon Consultation & Total Knee Replacement | Preferred Surgery Window: August 2025 |
This Quotation Estimate is issued by Medellín Surgical Excellence Center to provide a comprehensive, itemized breakdown of all costs associated with the engagement of a board-certified Surgeon and the full surgical team for the procedure described above. All services will be rendered at our accredited facility located in the El Poblado district of Colombia Medellín, which holds JCI (Joint Commission International) accreditation and is registered with the Colombian Ministry of Health (Ministerio de Salud y Protección Social).
The lead Surgeon assigned to this case is Dr. Carolina Restrepo, M.D., F.A.A.O.S., a fellowship-trained orthopedic surgeon with over 18 years of experience performing total joint replacements. Dr. Restrepo is a member of the Colombian Orthopedic and Traumatology Association (ASOTRA) and the American Academy of Orthopaedic Surgeons (AAOS). Her surgical team will include an anesthesiologist, two surgical nurses, a physiotherapist, and a post-operative care coordinator, all based in Colombia Medellín.
| Item No. | Description of Service | Quantity | Unit Price (USD) | Subtotal (USD) |
|---|---|---|---|---|
| 01 | Initial Surgeon Consultation & Pre-Operative Assessment (Colombia Medellín facility) | 1 | $450.00 | $450.00 |
| 02 | Pre-Surgical Diagnostic Workup (MRI, X-rays, Blood Panels, ECG, Anesthesia Evaluation) | 1 | $1,200.00 | $1,200.00 |
| 03 | Surgeon Professional Fee – Total Knee Replacement (Dr. C. Restrepo, M.D.) | 1 | $6,500.00 | $6,500.00 |
| 04 | Anesthesiologist Fee (General Anesthesia, Intra-operative Monitoring) | 1 | $1,800.00 | $1,800.00 |
| 05 | Operating Room & Surgical Team Fees (Nurses, Technicians, Equipment) | 1 | $2,200.00 | $2,200.00 |
| 06 | Implant – Total Knee Prosthesis (Zimmer Biomet or equivalent, FDA/CE certified) | 1 | $3,800.00 | $3,800.00 |
| 07 | Hospitalization – Inpatient Stay (3 nights, private room, Colombia Medellín) | 3 | $350.00 | $1,050.00 |
| 08 | Post-Operative Physiotherapy (10 sessions, on-site in Colombia Medellín) | 10 | $85.00 | $850.00 |
| 09 | Follow-Up Surgeon Visits (2 post-operative consultations at 6 weeks & 3 months) | 2 | $300.00 | $600.00 |
| 10 | Medical Coordination & Translation Services (English-Spanish, Colombia Medellín) | 1 | $500.00 | $500.00 |
| TOTAL ESTIMATED COST (USD) | $18,850.00 | |||
- This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiration date, the Surgeon's availability and pricing in Colombia Medellín may be subject to revision.
- A non-refundable deposit of 30% of the total estimated amount (USD $5,655.00) is required to reserve the Surgeon's schedule and secure the operating room in Colombia Medellín.
- The remaining 70% balance is due within 48 hours prior to the scheduled surgery date, payable via international wire transfer to the account designated by Medellín Surgical Excellence Center.
- The assigned Surgeon, Dr. Carolina Restrepo, will personally perform the procedure. In the event of an unforeseen medical emergency preventing her participation, an equally qualified orthopedic Surgeon of equivalent or superior credentials will be substituted, and the client will be notified and given the option to reschedule at no additional cost.
- All surgical procedures will comply with the regulations established by the Colombian Ministry of Health and the ethical guidelines of the Colombian Medical Association (Asociación Médica Colombiana).
- The client acknowledges that this Quotation Estimate represents a good-faith estimate and that final billing may vary by up to 10% depending on intra-operative findings, implant selection, or extended hospitalization. Any variance exceeding 10% will require prior written consent from the client.
- Medical records, operative reports, and discharge summaries will be provided to the client and their referring physician within five (5) business days following discharge from the facility in Colombia Medellín.
- This Quotation Estimate does not constitute a guarantee of specific surgical outcomes. The Surgeon will discuss all risks, benefits, and alternatives during the pre-operative consultation in accordance with informed consent protocols.
- Disputes arising from this Quotation Estimate shall be governed by the civil and commercial laws of the Republic of Colombia, with jurisdiction in the courts of Colombia Medellín, Antioquia.
By signing below, the client acknowledges receipt of this Quotation Estimate, confirms understanding of the scope of services provided by the Surgeon in Colombia Medellín, and authorizes the facility to proceed with scheduling upon receipt of the required deposit.
Client SignatureName: James R. Thompson
Date: ______________________ Authorized Representative – Medellín Surgical Excellence Center
Name: Dr. Carolina Restrepo, M.D.
Title: Lead Surgeon & Medical Director
Date: ______________________ ⬇️ Download as DOCX Edit online as DOCX
Create your own Word template with our GoGPT AI prompt:
GoGPT