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Purchase Order Doctor General Practitioner in United States Los Angeles –Free Word Template Download with AI

PO-2025-LA-04872

Doctor General Practitioner Medical Supply & Equipment Procurement

United States Los Angeles, California 90012

Purchase Order Number: PO-2025-LA-04872
Date of Issue: June 12, 2025
Required Delivery Date: July 15, 2025
Payment Terms: Net 30 Days
Currency: USD (United States Dollar)
Incoterms: DDP – Los Angeles, CA
BUYER INFORMATION
Practice Name: Pacific Coast General Practice, LLC Practice Type: Doctor General Practitioner Clinic
Address: 1420 Wilshire Boulevard, Suite 310, Los Angeles, California 90012, United States Phone: (213) 555-0187
Primary Physician: Dr. Margaret Chen, MD – Doctor General Practitioner Email: [email protected]
CA Medical Board License: CA-4829173 Tax ID (EIN): 82-4471903
SELLER / SUPPLIER INFORMATION
Company: MedEquip West Coast Distribution, Inc. Supplier ID: MCW-2025-0091
Address: 2800 Industrial Avenue, Long Beach, California 90810, United States Phone: (562) 555-0342
Contact Person: Robert Tanaka, Regional Sales Director Email: [email protected]
LINE ITEMS – Doctor General Practitioner Practice Equipment & Supplies
Item # Description SKU Qty Unit Price (USD) Extended Price (USD)
1 Examination Table with Adjustable Backrest – For Doctor General Practitioner patient consultations in Los Angeles clinic EX-TBL-4400 2 $2,850.00 $5,700.00
2 Digital Blood Pressure Monitor (Omron HBP-272) – Standard Doctor General Practitioner diagnostic tool BP-OMR-272 4 $189.99 $759.96
3 Electronic Stethoscope (Littmann Cardiology IV) – For Doctor General Practitioner auscultation procedures STH-LIT-CIV 3 $425.00 $1,275.00
4 Portable ECG Machine (12-Lead) – For Doctor General Practitioner cardiac screening in United States Los Angeles facility ECG-12L-PRO 1 $4,200.00 $4,200.00
5 Ophthalmoscope & Otoscope Combination Set – Doctor General Practitioner head and neck examination kit OPH-OTO-COMBO 2 $310.00 $620.00
6 Thermometer, Infrared Forehead (Non-Contact) – For Doctor General Practitioner triage in Los Angeles waiting room THM-IRF-001 6 $78.50 $471.00
7 Medical Examination Gloves (Nitrile, Box of 100) – 12-month supply for Doctor General Practitioner clinic operations GLV-NIT-100 48 $12.75 $612.00
8 Autoclave Sterilizer (Benchtop, 18L) – For Doctor General Practitioner instrument sterilization per California health code ACL-BT-18L 1 $1,890.00 $1,890.00
9 Electronic Medical Records Software License (Annual) – Doctor General Practitioner practice management system, United States compliant EMR-SW-ANL 1 $3,600.00 $3,600.00
10 First Aid & Emergency Response Kit (OSHA Compliant) – For Doctor General Practitioner clinic in Los Angeles, CA FAK-OSHA-STD 2 $245.00 $490.00
Subtotal: $19,617.96
California Sales Tax (7.25%): $1,422.30
Shipping & Handling (Los Angeles Metro): $385.00
TOTAL AMOUNT DUE (USD): $21,425.26
TERMS AND CONDITIONS
  1. This Purchase Order is issued by Pacific Coast General Practice, LLC, a Doctor General Practitioner clinic operating in United States Los Angeles, California, and constitutes a binding offer to purchase the goods and services listed herein upon acceptance by the Supplier.
  2. All items listed in this Purchase Order are intended for use in a Doctor General Practitioner medical practice and must comply with all applicable United States Food and Drug Administration (FDA) regulations, California Department of Public Health standards, and Los Angeles County medical facility requirements.
  3. Delivery shall be made to the Buyer's facility located at 1420 Wilshire Boulevard, Suite 310, Los Angeles, California 90012, United States. The Supplier is responsible for all transportation, insurance, and risk of loss until goods are received and inspected at the designated Los Angeles address.
  4. Payment shall be made within thirty (30) calendar days of the date of invoice receipt, via ACH transfer or certified check, to the account designated by the Buyer. Late payments shall accrue interest at a rate of 1.5% per month as permitted under California Commercial Code Section 2310.
  5. The Supplier warrants that all medical equipment and supplies provided under this Purchase Order are new, unused, and free from defects in materials and workmanship. A minimum two-year manufacturer's warranty is required for all capital equipment items.
  6. The Doctor General Practitioner practice reserves the right to inspect all delivered goods within five (5) business days of receipt. Any items found to be damaged, defective, or non-conforming to the specifications in this Purchase Order shall be returned at the Supplier's expense and replaced within ten (10) business days.
  7. This Purchase Order is governed by the laws of the State of California, United States. Any disputes arising from this Purchase Order shall be subject to the exclusive jurisdiction of the state or federal courts located in Los Angeles County, California.
  8. The Supplier shall maintain adequate professional liability insurance (minimum $2,000,000 per occurrence) throughout the term of this Purchase Order and shall provide a certificate of insurance upon request.
  9. All personal health information (PHI) or patient data that may be incidentally handled in connection with this Purchase Order shall be protected in accordance with the Health Insurance Portability and Accountability Act (HIPAA) and California Confidentiality of Medical Information Act (CMIA).
  10. This Purchase Order may not be assigned or transferred by either party without the prior written consent of the other party. Any modifications to this Purchase Order must be made in writing and signed by authorized representatives of both the Doctor General Practitioner practice and the Supplier.
NOTES AND SPECIAL INSTRUCTIONS

All capital equipment (Items 1, 4, and 8) must be delivered to the second floor of the Los Angeles facility and installed by certified technicians. The Doctor General Practitioner clinic will be closed on the scheduled delivery day (July 15, 2025) to accommodate installation. Please coordinate with the front desk at (213) 555-0187 at least 48 hours prior to delivery. All items must be properly labeled with the Purchase Order number PO-2025-LA-04872 for receiving verification. The EMR software license (Item 9) must be activated and configured for a Doctor General Practitioner practice with a maximum of 15 concurrent user seats, compliant with United States Los Angeles municipal health data storage regulations.

Authorized by (Buyer):

Dr. Margaret Chen, MD
Doctor General Practitioner – Principal Physician
Pacific Coast General Practice, LLC
Los Angeles, California, United States
Date: ______________________

Accepted by (Supplier):

Robert Tanaka
Regional Sales Director
MedEquip West Coast Distribution, Inc.
Long Beach, California, United States
Date: ______________________

This Purchase Order document was generated for Pacific Coast General Practice, LLC – a Doctor General Practitioner clinic in United States Los Angeles, California. Document Reference: PO-2025-LA-04872. This document is valid for 60 days from the date of issue. For questions regarding this Purchase Order, contact the procurement office at [email protected] or (213) 555-0187. All transactions are subject to the terms and conditions stated herein and applicable United States federal and California state regulations.

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