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Purchase Order Occupational Therapist in Indonesia Jakarta –Free Word Template Download with AI

PT. Nusantara Medika Sejahtera

Jl. Jend. Sudirman Kav. 52-53, SCBD District, Jakarta Selatan, Indonesia Jakarta 12190

Tel: +62-21-520-8899 | Email: [email protected]

NPWP: 01.234.567.8-011.000

Purchase Order Details

Purchase Order No.: PO/OM/2025/00472

Date of Issue: 15 June 2025

Required Service Start: 01 July 2025

Contract Duration: 12 months (01 Jul 2025 – 30 Jun 2026)

Payment Terms: Net 30 days from invoice date

Currency: Indonesian Rupiah (IDR)

Service Provider (Supplier)

Name: Bpk. Andi Wijaya, M.OT, OT (R)

Designation: Licensed Occupational Therapist

Practice: Klinik Terapi Okupasi Wijaya

Address: Jl. Gatot Subroto No. 88, Kuningan, Jakarta Selatan, Indonesia Jakarta 12950

License No.: OT-IND-2019-004521

Tax ID (NPWP): 09.876.543.2-012.000

Contact: +62-812-3456-7890

Line Items – Occupational Therapist Professional Services
No. Description of Service Unit Quantity Unit Price (IDR) Total (IDR)
1 Occupational Therapist – Outpatient Assessment & Treatment (Adult Rehabilitation), 60-minute session Session 240 1,250,000 300,000,000
2 Occupational Therapist – Pediatric Occupational Therapy Program, 45-minute session Session 180 1,100,000 198,000,000
3 Occupational Therapist – In-Home Visit & Environmental Modification Consultation (Jakarta area) Visit 60 2,500,000 150,000,000
4 Occupational Therapist – Group Therapy Workshop (up to 8 participants), 90-minute session Session 48 3,200,000 153,600,000
5 Occupational Therapist – Case Management, Progress Reporting & Interdisciplinary Team Meetings Month 12 8,500,000 102,000,000
6 Occupational Therapist – Emergency / After-Hours Consultation (on-call retainer) Month 12 3,000,000 36,000,000
SUBTOTAL 939,600,000
VAT (PPN) 11% 103,356,000
GRAND TOTAL 1,042,956,000
Scope of Work & Service Location

This Purchase Order authorizes the engagement of a qualified Occupational Therapist to deliver comprehensive therapeutic services to patients of PT. Nusantara Medika Sejahtera. All in-facility services shall be performed at our primary rehabilitation center located in the SCBD District, Indonesia Jakarta (South Jakarta). Home-visit services and community-based group workshops may be conducted at various residential and community locations throughout the Indonesia Jakarta metropolitan area, including but not limited to South Jakarta, Central Jakarta, North Jakarta, East Jakarta, and West Jakarta administrative regions. The Occupational Therapist is expected to maintain full compliance with the Indonesian Ministry of Health regulations (Permenkes) governing occupational therapy practice, as well as the professional code of ethics established by the Indonesian Association of Occupational Therapists (Himpunan Terapis Okupasi Indonesia – HTOI).

Terms and Conditions
  1. This Purchase Order is valid for acceptance within five (5) business days from the date of issue. Failure to confirm acceptance within this period shall render this Purchase Order null and void.
  2. The Occupational Therapist must hold a valid, current professional license issued by the Indonesian Ministry of Health and must maintain professional liability insurance with a minimum coverage of IDR 5,000,000,000 for the entire contract duration.
  3. Payment shall be processed via bank transfer to the account designated by the Occupational Therapist within thirty (30) calendar days of receipt of a valid tax invoice (faktur pajak) issued in accordance with Indonesian tax regulations.
  4. The Occupational Therapist shall submit a detailed monthly progress report to the Rehabilitation Department Head no later than the 5th business day of the following month. Reports must include patient outcomes, session notes, and any recommended modifications to the treatment plan.
  5. Any change in scope, additional sessions beyond the quantities stated in this Purchase Order, or modification of service locations within Indonesia Jakarta must be approved in writing via a formal Purchase Order amendment signed by both parties.
  6. The Occupational Therapist agrees to maintain strict patient confidentiality in accordance with Indonesian Law No. 36 of 2009 on Health and the personal data protection provisions of Law No. 27 of 2022 (UU PDP).
  7. Either party may terminate this Purchase Order with thirty (30) days written notice. In the event of termination, all services rendered up to the effective date of termination shall be invoiced and paid in full.
  8. All disputes arising from this Purchase Order shall be resolved through mediation in Indonesia Jakarta before any litigation is commenced. The governing law shall be the laws of the Republic of Indonesia.
  9. The Occupational Therapist shall not subcontract or delegate any portion of the services described in this Purchase Order without prior written consent from PT. Nusantara Medika Sejahtera.
Acceptance & Authorization

By signing below, both parties acknowledge and agree to all terms, conditions, and service specifications outlined in this Purchase Order for the engagement of the Occupational Therapist in Indonesia Jakarta. This document constitutes a binding agreement effective from the date of the last signature.

For PT. Nusantara Medika Sejahtera (Buyer)
Name: Dr. Ratna Kusuma, Sp.KFR
Title: Head of Rehabilitation Department
Date: _______________
For Klinik Terapi Okupasi Wijaya (Occupational Therapist)
Name: Bpk. Andi Wijaya, M.OT, OT (R)
Title: Lead Occupational Therapist
Date: _______________

This Purchase Order (PO/OM/2025/00472) was issued by PT. Nusantara Medika Sejahtera, Indonesia Jakarta. For inquiries, contact the Procurement Department at [email protected] or +62-21-520-8899 ext. 204.

Document Reference: PO/OM/2025/00472 | Version 1.0 | Confidential – For Internal Use Only

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