Purchase Order Midwife in United States San Francisco –Free Word Template Download with AI
Golden Gate Maternal Health Services, Inc.
1200 Market Street, Suite 450, San Francisco, California 94102, United States
Phone: (415) 555-0187 | Email: [email protected]
Tax ID (EIN): 94-2837461
Vendor / Service Provider Information| Provider Name: | Certificate of Midwifery Practice – Dr. Elena Vasquez, CNM (Certified Nurse-Midwife) |
| Practice Address: | 2847 Fillmore Street, San Francisco, California 94115, United States |
| License No.: | CA-CNM-2019-00482 (California Board of Registered Nursing) |
| Contact: | Dr. Elena Vasquez | (415) 555-0342 | [email protected] |
| Specialization: | Comprehensive Midwife-Led Prenatal, Intrapartum, and Postpartum Care |
| Organization: | Golden Gate Maternal Health Services, Inc. |
| Address: | 1200 Market Street, Suite 450, San Francisco, California 94102, United States |
| Accounts Payable Contact: | Ms. Patricia Huang, Senior Procurement Officer |
| Item # | Description of Midwife Service | Qty | Unit | Unit Price (USD) | Extended Price (USD) |
|---|---|---|---|---|---|
| 1 | Initial Midwife Prenatal Consultation and Comprehensive Obstetric Assessment (San Francisco, CA) | 1 | Session | $350.00 | $350.00 |
| 2 | Routine Midwife Prenatal Visits – First Trimester (Weeks 8–13), San Francisco Practice | 4 | Visits | $225.00 | $900.00 |
| 3 | Routine Midwife Prenatal Visits – Second Trimester (Weeks 14–27), San Francisco Practice | 6 | Visits | $225.00 | $1,350.00 |
| 4 | Routine Midwife Prenatal Visits – Third Trimester (Weeks 28–40), San Francisco Practice | 8 | Visits | $250.00 | $2,000.00 |
| 5 | Midwife-Led Labor and Delivery Support (Hospital or Home Birth, San Francisco, United States) | 1 | Event | $4,500.00 | $4,500.00 |
| 6 | Postpartum Midwife Visits – Newborn and Maternal Recovery (Weeks 1–6 Postpartum) | 4 | Visits | $200.00 | $800.00 |
| 7 | Midwife-Administered Laboratory Tests and Diagnostic Imaging Coordination (San Francisco Labs) | 1 | Package | $1,200.00 | $1,200.00 |
| 8 | Emergency Midwife On-Call Availability and After-Hours Coverage (San Francisco Metro Area) | 1 | Contract | $600.00 | $600.00 |
| 9 | Midwife-Prepared Birth Plan Consultation and Documentation (San Francisco, CA) | 1 | Session | $175.00 | $175.00 |
| 10 | Lactation Support and Breastfeeding Guidance by Certified Midwife (Postpartum, San Francisco) | 3 | Sessions | $150.00 | $450.00 |
| Subtotal: | $12,325.00 | ||||
| California Sales Tax (8.25%): | $1,016.81 | ||||
| TOTAL AMOUNT DUE (USD): | $13,341.81 | ||||
- This Purchase Order constitutes a formal request for Midwife services to be rendered within the jurisdiction of San Francisco, California, United States. All services shall comply with the California Business and Professions Code and the regulations set forth by the California Board of Registered Nursing governing Certified Nurse-Midwives.
- The Midwife provider, Dr. Elena Vasquez, CNM, shall deliver all services in accordance with the standards of care established by the American College of Nurse-Midwives (ACNM) and the American College of Obstetricians and Gynecologists (ACOG) guidelines applicable in the United States.
- Payment terms: Net 30 days from the date of invoice submission. Payment shall be made via ACH transfer to the account designated by the Midwife provider. Late payments shall incur a 1.5% monthly interest charge as permitted under California Civil Code Section 3289.
- All Midwife services listed in this Purchase Order are to be performed at the provider's practice located in San Francisco, California, United States, unless otherwise specified for hospital-based or home-birth settings within the San Francisco metropolitan area.
- The Midwife provider shall maintain valid professional liability insurance with a minimum coverage of $2,000,000 per occurrence and $5,000,000 aggregate, as required for midwifery practice in the State of California.
- Any modifications, cancellations, or substitutions to the services outlined in this Purchase Order must be approved in writing by both parties. The Midwife provider shall notify Golden Gate Maternal Health Services, Inc. at least 48 hours in advance of any schedule changes.
- This Purchase Order is governed by the laws of the State of California and the federal laws of the United States. Any disputes arising from this Purchase Order shall be resolved through binding arbitration in San Francisco, California, in accordance with the California Arbitration Act.
- The Midwife provider warrants that all services will be performed with the skill, care, and diligence expected of a reasonably competent Certified Nurse-Midwife practicing in San Francisco, United States, and in full compliance with all applicable federal, state, and local health regulations.
- Confidentiality: All patient health information obtained during the course of Midwife services shall be protected in accordance with the Health Insurance Portability and Accountability Act (HIPAA) and the California Confidentiality of Medical Information Act (CMIA).
- This Purchase Order is valid for a period of thirty (30) days from the date of issue. If not accepted and countersigned by the Midwife provider within this period, this Purchase Order shall be considered void and of no effect.
Authorized by (Buyer):
Patricia HuangSenior Procurement Officer
Golden Gate Maternal Health Services, Inc.
Date: _______________
Accepted by (Midwife Provider):
Dr. Elena Vasquez, CNMCertified Nurse-Midwife
San Francisco Midwifery Practice
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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