Purchase Order Nurse in United States Chicago –Free Word Template Download with AI
Professional Nurse Services Procurement Document
Issued in United States Chicago, Illinois
1. Purchasing Entity (Buyer)| Organization: Lakeview Medical Group, LLC | Address: 2333 N. Lake Shore Drive, Suite 1400, United States Chicago, IL 60614 |
| Contact Person: Margaret Ellison, Director of Procurement | Phone / Email: (312) 555-0198 / [email protected] |
| Tax ID (EIN): 36-4829105 | State of Operation: Illinois, United States |
| Organization: Midwest Healthcare Staffing Solutions, Inc. | Address: 1500 W. Madison Street, Floor 3, United States Chicago, IL 60607 |
| Contact Person: David Okafor, Account Manager | Phone / Email: (773) 555-0342 / [email protected] |
| Tax ID (EIN): 36-7712458 | License No. (IL): IL-HCS-2019-00447 |
This Purchase Order is issued by Lakeview Medical Group, LLC, a healthcare facility operating in United States Chicago, to procure the professional services of a licensed Nurse for ongoing patient care, clinical support, and medical administration duties. The Nurse engaged under this Purchase Order shall be a Registered Nurse (RN) or Licensed Practical Nurse (LPN) holding a valid Illinois State Board of Nursing license, with a minimum of five (5) years of clinical experience in acute care, outpatient, or long-term care settings within the United States Chicago metropolitan area.
4. Line Items and Pricing| Item # | Description | Quantity | Unit Rate (USD) | Extended Price (USD) |
|---|---|---|---|---|
| 1 | Registered Nurse (RN) – Full-Time Clinical Services (40 hrs/week) – Patient assessment, medication administration, wound care, and vital monitoring at Lakeview Medical Group facility in United States Chicago | 1 position / 13 weeks | $4,200.00 | $54,600.00 |
| 2 | Licensed Practical Nurse (LPN) – Part-Time Support (20 hrs/week) – Assistance with patient intake, documentation, and post-operative care in United States Chicago | 1 position / 13 weeks | $2,100.00 | $27,300.00 |
| 3 | Nurse Onboarding, Background Verification, and Illinois Licensure Compliance Processing | 1 service | $1,850.00 | $1,850.00 |
| 4 | Continuing Education and Certification Renewal for Nurse staff (IL Board of Nursing compliance) | 2 nurses | $450.00 | $900.00 |
| 5 | Personal Protective Equipment (PPE) and Clinical Supplies allocated to Nurse personnel | 13 weeks | $320.00 | $4,160.00 |
| Subtotal: | $88,810.00 | |||
| Illinois State Sales Tax (6.25%): | $5,550.63 | |||
| Chicago Municipal Tax (2.5%): | $2,220.25 | |||
| TOTAL PURCHASE ORDER AMOUNT: | $96,580.88 | |||
- Scope of Nurse Services: The Nurse(s) procured under this Purchase Order shall perform all duties consistent with their Illinois nursing license scope of practice. All clinical activities shall be conducted at the Lakeview Medical Group facility located in United States Chicago, IL 60614, or at approved satellite locations within the City of Chicago.
- Licensure and Compliance: The vendor shall ensure that every Nurse assigned under this Purchase Order maintains an active, unrestricted license issued by the Illinois Department of Financial and Professional Regulation (IDFPR). The Nurse must also hold a current BLS/ACLS certification from the American Heart Association. Failure to maintain licensure shall constitute immediate grounds for termination of this Purchase Order.
- Payment Terms: Payment shall be made within thirty (30) days of invoice receipt. Invoices must reference this Purchase Order number (PO-CHI-2025-04872). Payment will be processed via ACH transfer to the vendor's designated bank account in United States Chicago. Late payments shall accrue interest at 1.5% per month.
- Service Location: All Nurse services rendered under this Purchase Order shall be physically performed within the boundaries of the City of Chicago, Cook County, Illinois, United States. Remote or telehealth components, if any, must be pre-approved in writing by the Buyer.
- Confidentiality and HIPAA: The Nurse(s) shall be bound by the Health Insurance Portability and Accountability Act (HIPAA) and all applicable Illinois privacy statutes. The vendor shall execute a Business Associate Agreement (BAA) prior to the Nurse's first day of service. All patient records and clinical data remain the property of Lakeview Medical Group.
- Insurance and Indemnification: The vendor shall maintain professional liability (malpractice) insurance of no less than $2,000,000 per occurrence and $5,000,000 aggregate, naming Lakeview Medical Group as an additional insured. The Nurse shall be covered under the vendor's workers' compensation policy as required by Illinois law.
- Termination: Either party may terminate this Purchase Order with fourteen (14) days written notice. In the event of termination, the Buyer shall pay for all Nurse services rendered through the effective date of termination. No penalty shall apply for early termination due to the Nurse's failure to meet clinical competency standards.
- Governing Law: This Purchase Order shall be governed by and construed in accordance with the laws of the State of Illinois, United States. Any disputes shall be resolved through binding arbitration in United States Chicago, in accordance with the rules of the American Arbitration Association.
- Non-Assignment: The vendor shall not assign or subcontract any Nurse services under this Purchase Order without prior written consent from the Buyer. The specific Nurse(s) identified or to be identified must be approved by the Buyer's Director of Clinical Operations.
- Force Majeure: Neither party shall be liable for delays or failures in performance under this Purchase Order caused by acts of God, natural disasters, pandemics, government mandates, or other events beyond reasonable control, provided that the affected party notifies the other within five (5) business days.
By signing below, both parties acknowledge and agree to all terms, conditions, and specifications outlined in this Purchase Order for the procurement of Nurse services in United States Chicago. This document constitutes a binding agreement effective as of the date of the last signature.
Authorized Signature – BuyerMargaret Ellison, Director of Procurement
Lakeview Medical Group, LLC
Date: ______________________ Authorized Signature – Vendor
David Okafor, Account Manager
Midwest Healthcare Staffing Solutions, Inc.
Date: ______________________ ⬇️ Download as DOCX Edit online as DOCX
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