Purchase Order Dietitian in United States Houston –Free Word Template Download with AI
Memorial Hermann Health System – Procurement & Supply Chain Division
6421 Fannin Street, Suite 1200, Houston, Texas 77030, United States
Phone: (713) 555-0142 | Email: [email protected]
Registered Dietitian: Dr. Elena R. Vasquez, RD, LD, FADAPractice Name: Gulf Coast Clinical Nutrition Associates
Address: 2901 Post Oak Boulevard, Suite 850, Houston, Texas 77056, United States
Phone: (713) 555-0387
Email: [email protected]
State License No.: TX-RDN-2019-44821
Federal EIN: 74-2839105
Professional Designation: Registered Dietitian Nutritionist (RDN), Board-Certified Specialist in Renal Nutrition (CSR) Memorial Hermann – Texas Medical Center Campus
6421 Fannin Street, Houston, Texas 77030, United States
Attn: Dr. James Okafor, Chief of Internal Medicine
Service Location: Inpatient Nutrition Wing, 3rd Floor, Houston, TX 77030
| Item # | Description of Dietitian Services | Qty | Unit | Unit Rate (USD) | Extended Amount (USD) |
|---|---|---|---|---|---|
| 001 | Comprehensive inpatient Dietitian consultation for renal nutrition management – initial patient assessment, dietary history, and individualized meal plan development for patients admitted to the Nephrology unit in Houston, Texas. | 120 | Consultations | $185.00 | $22,200.00 |
| 002 | Weekly Dietitian-led multidisciplinary team (MDT) meetings with physicians, nurses, and social workers to review patient nutritional status, adjust therapeutic diets, and coordinate discharge nutrition planning at the Houston facility. | 16 | Weeks | $1,200.00 | $19,200.00 |
| 003 | Outpatient Dietitian follow-up sessions for post-discharge patients residing in the greater Houston, United States metropolitan area, including dietary counseling, food journal review, and progress monitoring over a 90-day period. | 200 | Sessions | $140.00 | $28,000.00 |
| 004 | Development and delivery of a patient education workshop series on Mediterranean and DASH dietary patterns for cardiovascular risk reduction, to be conducted at the Memorial Hermann community health center in Houston, Texas. | 8 | Workshops | $950.00 | $7,600.00 |
| 005 | Preparation of a quarterly clinical nutrition audit report documenting Dietitian interventions, patient outcomes, and compliance metrics for the Houston medical center, submitted to the Quality Assurance Committee. | 1 | Report | $3,500.00 | $3,500.00 |
| 006 | Emergency on-call Dietitian coverage (24/7 availability) for critical care nutrition support in the Intensive Care Unit, Houston, Texas, including enteral and parenteral nutrition protocol management. | 1 | Quarter | $6,800.00 | $6,800.00 |
| Subtotal | $87,300.00 | ||||
| Applicable Texas Sales & Service Tax (8.25%) | $7,202.25 | ||||
| Grand Total (USD) | $94,502.25 | ||||
- This Purchase Order constitutes a binding agreement between Memorial Hermann Health System (hereinafter "the Buyer") and Gulf Coast Clinical Nutrition Associates, represented by Dr. Elena R. Vasquez, Registered Dietitian (hereinafter "the Vendor"), for the provision of professional Dietitian services as described in the line items above.
- All Dietitian services shall be performed at the designated service location in Houston, Texas, United States, or at such other location within the Houston metropolitan area as mutually agreed upon in writing by both parties.
- The Vendor warrants that the Dietitian services shall be rendered in full compliance with the Texas State Board of Dietetics and Nutrition, the Academy of Nutrition and Dietetics (AND) Code of Ethics, and all applicable federal and state regulations governing clinical nutrition practice in the United States.
- Payment shall be made within thirty (30) calendar days of receipt of a valid invoice from the Vendor. Invoices must reference this Purchase Order number (PO-2025-HOU-04872) and shall be submitted to the Accounts Payable department at the Houston, Texas address listed above.
- The Vendor shall maintain professional liability insurance with a minimum coverage of $2,000,000 per occurrence and $5,000,000 aggregate, naming Memorial Hermann Health System as an additional insured. A certificate of insurance shall be provided prior to the commencement of any Dietitian services.
- All patient health information accessed or generated during the course of Dietitian services shall be handled in strict accordance with the Health Insurance Portability and Accountability Act (HIPAA) and the Texas Medical Records Privacy Act. A Business Associate Agreement (BAA) is attached hereto as Exhibit A.
- The Buyer reserves the right to modify, suspend, or cancel this Purchase Order in whole or in part upon fifteen (15) days written notice. In the event of cancellation, the Vendor shall be compensated for all Dietitian services rendered up to the effective date of cancellation.
- This Purchase Order shall be governed by and construed in accordance with the laws of the State of Texas and the federal laws of the United States. Any disputes arising hereunder shall be resolved through binding arbitration in Houston, Texas, in accordance with the rules of the American Arbitration Association.
- The Vendor acknowledges that all Dietitian services performed under this Purchase Order are subject to the clinical oversight and medical direction of the attending physicians at the Houston facility. The Dietitian shall not deviate from established clinical protocols without prior written authorization from the supervising physician.
- This Purchase Order is valid for a period of one (1) year from the date of issue, unless renewed in writing by both parties. The Vendor shall maintain current licensure as a Registered Dietitian in the State of Texas throughout the term of this agreement.
By signing below, both parties acknowledge and agree to the terms, conditions, and scope of Dietitian services outlined in this Purchase Order for delivery in Houston, United States.
Sandra M. Whitfield
Procurement Manager, Memorial Hermann Health System
Date: ____________________
Dr. Elena R. Vasquez, RD, LD
Registered Dietitian, Gulf Coast Clinical Nutrition Associates
Date: ____________________
Create your own Word template with our GoGPT AI prompt:
GoGPT