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Purchase Order Doctor General Practitioner in United States San Francisco –Free Word Template Download with AI

Doctor General Practitioner — United States San Francisco

Purchase Order Details

Purchase Order Number: PO-SF-2025-04872

Date of Issue: June 12, 2025

Required Delivery Date: July 1, 2025

Payment Terms: Net 30 Days

Currency: USD (United States Dollar)

Buyer Information

Dr. Margaret L. Chen, M.D.

Doctor General Practitioner

Bay Area Primary Care Associates

1847 Market Street, Suite 420

San Francisco, California 94102

United States

Tel: (415) 555-0193

Email: [email protected]

CA Medical License: A-1284756

Vendor / Supplier Information

MedSupply Pacific, Inc.

4200 Industrial Parkway, Building C

Oakland, California 94601

United States

Tel: (510) 555-7742

Vendor Account Number: V-88214

Tax ID (EIN): 94-2210873

Purpose and Scope of This Purchase Order

This Purchase Order is issued by Dr. Margaret L. Chen, a licensed Doctor General Practitioner operating a primary care clinic in the United States San Francisco metropolitan area, to procure essential medical supplies, diagnostic equipment, and office consumables necessary for the continued operation of the practice. As a Doctor General Practitioner serving the diverse patient population of San Francisco, California, the clinic requires a steady and reliable supply of pharmaceutical-grade materials, examination instruments, and administrative resources to maintain the highest standard of patient care in compliance with all California State Board of Medicine regulations and federal healthcare standards.

Line Items

Item # Description Qty Unit Unit Price (USD) Line Total (USD)
1Nitrile Examination Gloves, Medium, Box of 100 (FDA Approved)50Box$14.99$749.50
2Disposable Stethoscope Diaphragms, Universal Fit, Pack of 2520Pack$8.75$175.00
3Electrocardiogram (ECG) Paper Rolls, 12-Lead, 100m15Roll$22.50$337.50
4Blood Pressure Cuffs, Adult, Adjustable (Various Sizes)10Unit$34.00$340.00
5OTC Analgesic Tablets, Ibuprofen 400mg, 500ct Bottle (Patient Supply)30Bottle$12.99$389.70
6Medical Face Masks, 3-Ply, Box of 50 (N95 Equivalent)40Box$18.50$740.00
7Sharps Disposal Containers, 2L, Autoclavable, Box of 1012Box$27.00$324.00
8Patient Intake Forms and Medical History Sheets, 500ct8Set$15.00$120.00
9Digital Thermometers, Clinical Grade, Individually Packed25Unit$9.99$249.75
10Antiseptic Hand Sanitizer, 70% Alcohol, 1L Pump Bottle60Bottle$6.50$390.00
11IV Start Kits, 20G, Sterile, Box of 2510Box$45.00$450.00
12Pulse Oximeter Probes, Adult, Reusable, with Cables15Unit$28.00$420.00

Cost Summary

Subtotal$4,705.45
California Sales Tax (8.5%)$399.96
Freight and Delivery (San Francisco, CA)$85.00
Purchase Order Total (USD)$5,190.41

Delivery Instructions

All items listed in this Purchase Order shall be delivered to the Bay Area Primary Care Associates clinic located at 1847 Market Street, Suite 420, San Francisco, California 94102, United States. Delivery must be made between the hours of 8:00 AM and 4:00 PM Pacific Daylight Time (PDT) on a business day. The receiving contact for this Purchase Order is Dr. Chen's office manager, Mr. David Park, who must be present to inspect and sign for the shipment. The vendor is requested to provide a Bill of Lading and a copy of the corresponding invoice upon delivery. All medical supplies must be within their expiration dates and must arrive in unopened, factory-sealed packaging. Perishable or temperature-sensitive items, if applicable, must be shipped in insulated containers with appropriate cold-chain documentation.

Terms and Conditions

  1. This Purchase Order constitutes a binding agreement between the Doctor General Practitioner (Buyer) and MedSupply Pacific, Inc. (Vendor) upon written acceptance by both parties.
  2. All goods must comply with the United States Food and Drug Administration (FDA) regulations and California state healthcare supply standards. The Vendor warrants that all items are new, unused, and free from defects.
  3. Payment of $5,190.41 USD shall be made via ACH bank transfer within thirty (30) calendar days of the date of invoice receipt, provided all items have been inspected and accepted in satisfactory condition.
  4. The Vendor shall bear all risk of loss until the goods are delivered and signed for at the San Francisco, United States delivery address specified herein.
  5. In the event of non-conforming or damaged goods, the Buyer reserves the right to reject the affected items and request a full replacement or credit within fourteen (14) business days of delivery.
  6. This Purchase Order is governed by the laws of the State of California and the United States of America. Any disputes arising from this Purchase Order shall be resolved in the courts of San Francisco County, California.
  7. The Vendor agrees to maintain all patient-related data and clinic information in strict confidence in accordance with the Health Insurance Portability and Accountability Act (HIPAA) and California Confidentiality of Medical Information Act (CMIA).
  8. Any modifications to this Purchase Order must be made in writing and signed by both the Doctor General Practitioner and an authorized representative of the Vendor.
Note: This Purchase Order was prepared in accordance with the operational needs of a Doctor General Practitioner's primary care practice in the United States San Francisco area. All quantities reflect the projected patient volume for the upcoming quarter. The Doctor General Practitioner reserves the right to adjust quantities by up to 10% without issuing a revised Purchase Order, subject to Vendor availability.

Authorization and Signatures

By signing below, the undersigned parties acknowledge and agree to all terms, conditions, and line items specified in this Purchase Order for the Doctor General Practitioner practice in United States San Francisco.

Buyer (Doctor General Practitioner):

Dr. Margaret L. Chen, M.D.

Date: _______________

Vendor Representative:

Authorized Signatory, MedSupply Pacific, Inc.

Date: _______________

Purchase Order PO-SF-2025-04872 — Doctor General Practitioner — United States San Francisco — Page 1 of 1

Bay Area Primary Care Associates • 1847 Market Street, Suite 420, San Francisco, CA 94102 • (415) 555-0193

This document is the property of the issuing Doctor General Practitioner and is intended solely for the transaction described herein.

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