Quotation Estimate Surgeon in United Arab Emirates Dubai –Free Word Template Download with AI
MediSurge Dubai Healthcare Group LLC
Office 1204, Level 12, Burj Daman, DIFC, United Arab Emirates Dubai
Tel: +971 4 555 0192 | Email: [email protected]
Trade License No: 1048293 | DHA License: DH-2024-78451
This Quotation Estimate document has been prepared by MediSurge Dubai Healthcare Group LLC to provide a comprehensive and transparent financial breakdown for the engagement of a Surgeon and associated surgical services to be delivered at the client's facility located in United Arab Emirates Dubai. This Quotation Estimate covers all professional fees, consumables, equipment usage, and ancillary costs associated with the surgical procedures outlined below. All pricing is quoted in United Arab Emirates Dirhams (AED) and is subject to the terms and conditions stated in Section 6 of this document.
The Surgeon engaged under this Quotation Estimate shall be a board-certified specialist registered with the Dubai Health Authority (DHA) and the Ministry of Health and Prevention (MOHAP) of the United Arab Emirates. The Surgeon shall possess a minimum of fifteen (15) years of post-qualification experience in the relevant surgical discipline and shall maintain full malpractice insurance coverage as mandated by the regulatory authorities of United Arab Emirates Dubai.
| Item No. | Description of Service / Item | Quantity | Unit Price (AED) | Total (AED) |
|---|---|---|---|---|
| 01 | Consultation and Pre-operative Assessment by the Surgeon (includes imaging review, blood work authorization, and risk stratification) | 1 | 3,500.00 | 3,500.00 |
| 02 | Primary Surgical Procedure – Laparoscopic Cholecystectomy (Surgeon's professional fee, including intra-operative decision-making and technical execution) | 1 | 28,000.00 | 28,000.00 |
| 03 | Assistant Surgeon / First Assistant Fee (qualified surgical resident or fellow under DHA supervision) | 1 | 8,500.00 | 8,500.00 |
| 04 | Anesthesiologist Fee (General Anesthesia, intra-operative monitoring, and post-anesthesia care for 6 hours) | 1 | 12,000.00 | 12,000.00 |
| 05 | Operating Theatre Usage Fee (Level 1 OT, 4-hour block, including scrub nurse and circulating nurse) | 1 | 15,500.00 | 15,500.00 |
| 06 | Surgical Consumables and Implants (laparoscopic instruments, trocars, sutures, hemostatic agents, and disposable drapes) | 1 | 9,800.00 | 9,800.00 |
| 07 | Post-operative Ward Stay (Private single room, 2 nights, including nursing care and daily Surgeon review) | 2 | 4,200.00 | 8,400.00 |
| 08 | Post-operative Follow-up Consultations (Surgeon review at 7 days and 21 days, including wound inspection and suture removal) | 2 | 1,200.00 | 2,400.00 |
| 09 | Pathology and Histology Processing (tissue sample preparation, staining, and specialist report) | 1 | 2,800.00 | 2,800.00 |
| 10 | Emergency Contingency Allowance (5% of subtotal, applicable only in the event of intra-operative complications requiring extended intervention) | 1 | 4,095.00 | 4,095.00 |
| SUBTOTAL (AED) | 95,995.00 | |||
| VAT @ 5% (United Arab Emirates Dubai) | 4,799.75 | |||
| GRAND TOTAL (AED) | 100,794.75 | |||
The Surgeon designated for this engagement holds a DHA Specialist License (License No: DHA-SP-2024-33871) and is a member in good standing of the Dubai Medical Association. All surgical procedures shall be conducted in strict compliance with the regulations issued by the Dubai Health Authority and the Federal Law No. 2 of 2016 on the Regulation of the Health Sector in the United Arab Emirates. The Surgeon shall provide a written informed consent form in both Arabic and English prior to any procedure, as is standard practice in United Arab Emirates Dubai healthcare facilities.
Upon acceptance of this Quotation Estimate, the pre-operative consultation shall be scheduled within five (5) business days. The primary surgical procedure is estimated to be performed within fourteen (14) calendar days of the initial consultation, subject to operating theatre availability at the client's facility in United Arab Emirates Dubai. The total estimated duration of the surgical procedure is between two (2) and three and a half (3.5) hours, depending on intra-operative findings.
- This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. Any request for services beyond this period shall require a revised Quotation Estimate reflecting current market rates in United Arab Emirates Dubai.
- Payment terms: Fifty percent (50%) of the Grand Total shall be due upon acceptance of this Quotation Estimate as a booking deposit. The remaining fifty percent (50%) shall be settled within seven (7) business days following discharge from the post-operative ward.
- All payments shall be made in United Arab Emirates Dirhams (AED) via bank transfer to the account designated by MediSurge Dubai Healthcare Group LLC. No cash payments shall be accepted.
- The Surgeon reserves the right to modify the surgical approach intra-operatively if clinical findings necessitate a deviation from the planned procedure. Any additional costs arising from such modifications shall be communicated to the patient or authorized representative prior to implementation and shall be itemized in a supplementary Quotation Estimate.
- This Quotation Estimate does not include the cost of pre-operative imaging (CT, MRI, or ultrasound) unless specifically requested by the Surgeon and itemized in a separate addendum.
- Any cancellation by the client more than seventy-two (72) hours before the scheduled procedure shall result in a non-refundable deposit of AED 5,000.00. Cancellations within seventy-two (72) hours shall forfeit the full deposit.
- All medical records, operative notes, and pathology reports generated under this engagement shall be retained in accordance with the data protection regulations of the United Arab Emirates and the Dubai Health Authority's record-keeping standards.
- This Quotation Estimate is governed by the laws of the United Arab Emirates, and any disputes shall be subject to the exclusive jurisdiction of the courts of Dubai, United Arab Emirates.
By signing below, the client acknowledges receipt of this Quotation Estimate and agrees to the terms, conditions, and pricing outlined herein for the engagement of the Surgeon and associated surgical services in United Arab Emirates Dubai.
For MediSurge Dubai Healthcare Group LLCDr. Khalid Al Rashidi, MD, FACS
Lead Surgeon / Authorized Signatory
Date: _______________ For Al Maktoum Medical Center (Client)
Name: ___________________________
Title: ___________________________
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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