Purchase Order Occupational Therapist in United States Chicago –Free Word Template Download with AI
1421 N. Clark Street, Suite 800
Chicago, Illinois 60610
United States
Phone: (312) 555-0198
Email: [email protected]
Illinois Business License No.: IL-2024-8873421 Dr. Margaret A. Sullivan, OTR/L
Sullivan Occupational Therapy Group
742 W. Diversey Parkway, Unit 3B
Chicago, Illinois 60614
United States
Phone: (773) 555-0442
Email: [email protected]
Illinois OT License No.: OT-2019-44821
NPI: 1548392017
This Purchase Order is issued by Lakefront Rehabilitation & Wellness Center, LLC to procure the professional services of a licensed Occupational Therapist to deliver inpatient and outpatient rehabilitation programs at our facility located in the United States Chicago metropolitan area. The Occupational Therapist shall provide comprehensive evaluation, treatment planning, and hands-on therapeutic intervention for patients recovering from orthopedic injuries, neurological conditions, and post-surgical rehabilitation. All services shall be rendered in compliance with the Illinois Department of Public Health regulations and the standards set forth by the American Occupational Therapy Association (AOTA).
| Item # | Description of Service | Quantity | Unit | Unit Rate (USD) | Extended Amount (USD) |
|---|---|---|---|---|---|
| 001 | Initial Occupational Therapy Assessment & Treatment Plan Development (per patient) | 120 | Patients | $185.00 | $22,200.00 |
| 002 | Individualized Occupational Therapy Sessions (45-minute direct patient care) | 1,440 | Sessions | $110.00 | $158,400.00 |
| 003 | Group Occupational Therapy Program Facilitation (up to 6 patients per group) | 96 | Groups | $220.00 | $21,120.00 |
| 004 | Adaptive Equipment Evaluation & Recommendation (per patient) | 60 | Patients | $95.00 | $5,700.00 |
| 005 | Weekly Progress Documentation & Interdisciplinary Team Conference Participation | 52 | Weeks | $350.00 | $18,200.00 |
| 006 | Discharge Planning & Community Reintegration Coordination (per patient) | 120 | Patients | $140.00 | $16,800.00 |
| TOTAL CONTRACT VALUE | $242,420.00 | ||||
The Occupational Therapist engaged under this Purchase Order shall perform all duties within the Lakefront Rehabilitation & Wellness Center facility in Chicago, United States, as well as at approved satellite locations within Cook County, Illinois. The Occupational Therapist is expected to maintain a minimum caseload of twenty (20) active patients at any given time and shall adhere to evidence-based practice guidelines. All clinical documentation must be entered into the facility's electronic health record system (Epic) within twenty-four (24) hours of each patient encounter. The Occupational Therapist shall participate in monthly quality assurance reviews and annual competency assessments as mandated by the facility's accreditation body (Joint Commission).
- Contract Duration: This Purchase Order is valid for a period of twelve (12) months commencing July 1, 2025, and expiring June 30, 2026, unless renewed in writing by both parties no later than thirty (30) days prior to expiration.
- Payment Schedule: Invoices shall be submitted on the last business day of each calendar month. Payment shall be remitted via ACH transfer to the account designated by the Occupational Therapist within thirty (30) days of invoice receipt. Late payments shall accrue interest at a rate of 1.5% per month as permitted under Illinois law.
- Licensing & Compliance: The Occupational Therapist shall maintain an active, unrestricted license to practice occupational therapy in the State of Illinois, issued by the Illinois Department of Financial and Professional Regulation. The Occupational Therapist shall also maintain current Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) certifications throughout the term of this Purchase Order.
- Insurance Requirements: The Occupational Therapist shall carry professional liability (malpractice) insurance with a minimum coverage of $1,000,000 per occurrence and $3,000,000 in the aggregate. A certificate of insurance naming Lakefront Rehabilitation & Wellness Center, LLC as an additional insured shall be provided prior to the commencement of services.
- Confidentiality & HIPAA: The Occupational Therapist shall comply with all provisions of the Health Insurance Portability and Accountability Act (HIPAA), the Illinois Personal Information Protection Act, and all applicable federal and state privacy regulations governing patient health information in the United States Chicago healthcare environment.
- Termination: Either party may terminate this Purchase Order with thirty (30) days written notice. In the event of material breach, the non-breaching party may terminate immediately upon written notice. Termination shall not affect obligations accrued prior to the effective date of termination.
- Governing Law: This Purchase Order shall be governed by and construed in accordance with the laws of the State of Illinois and applicable federal law. Any disputes arising hereunder shall be resolved through binding arbitration in Chicago, United States, in accordance with the rules of the American Arbitration Association.
- Independent Contractor Status: The Occupational Therapist is engaged as an independent contractor and not as an employee of Lakefront Rehabilitation & Wellness Center, LLC. The Occupational Therapist shall be solely responsible for all federal, state, and local tax obligations, including self-employment tax, Illinois state income tax, and Chicago municipal tax obligations.
By signing below, both parties acknowledge that they have read, understood, and agree to all terms and conditions set forth in this Purchase Order for the engagement of Occupational Therapist services in the United States Chicago area. This document constitutes a binding agreement between the parties upon execution.
Authorized Representative — BuyerName: James R. Whitfield, Director of Procurement
Lakefront Rehabilitation & Wellness Center, LLC
Signature: ___________________________ Date: __________ Authorized Representative — Seller
Name: Dr. Margaret A. Sullivan, OTR/L
Sullivan Occupational Therapy Group
Signature: ___________________________ Date: __________ ⬇️ Download as DOCX Edit online as DOCX
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