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Purchase Order Occupational Therapist in United States New York City –Free Word Template Download with AI

PO No. NYC-OT-2025-04872

Occupational Therapist Services   United States New York City

Date of Issue: June 12, 2025  |  Valid Until: September 12, 2025

Field Details
Organization Name Manhattan Community Health & Rehabilitation Center
Address 452 West 57th Street, Suite 1200, United States New York City, NY 10019
Contact Person Dr. Eleanor Whitfield, Director of Clinical Services
Phone / Email (212) 555-0147 / [email protected]
Tax ID (EIN) 14-8823456
Field Details
Provider Name Bronx & Beyond Occupational Therapy Group, LLC
Address 88 Grand Concourse, Floor 3, United States New York City, NY 10456
Contact Person Marcus Delgado, PT, OTR/L – Lead Occupational Therapist
Phone / Email (718) 555-0392 / [email protected]
NY State License No. OT-2019-447821 (New York State Department of Health)

This Purchase Order authorizes the engagement of a licensed Occupational Therapist to deliver comprehensive outpatient and in-home rehabilitation services within the five boroughs of United States New York City. The Occupational Therapist shall be a board-certified professional (OTR/L) in good standing with the New York State Department of Health and shall adhere to all applicable federal and state regulations governing therapeutic practice in the United States New York City metropolitan area.

The scope of services includes but is not limited to: functional capacity assessments, adaptive equipment training, fine and gross motor skill development, sensory integration therapy, cognitive rehabilitation, and community reintegration programming. All sessions shall be conducted at the client's residence, a designated clinic within United States New York City, or a partner hospital facility as specified in the individualized treatment plan.

Item # Description Qty Unit Unit Price (USD) Extended Price (USD)
1 Occupational Therapist – Initial Comprehensive Assessment (per patient) 120 session $285.00 $34,200.00
2 Occupational Therapist – Ongoing Treatment Session (45 min, per patient) 1,440 session $195.00 $280,800.00
3 Occupational Therapist – In-Home Visit Surcharge (Manhattan, Brooklyn, Queens, Bronx, Staten Island) 360 visit $45.00 $16,200.00
4 Adaptive Equipment Evaluation & Recommendation Report 80 report $150.00 $12,000.00
5 Family/Caregiver Training Workshop (group of up to 10) 12 workshop $400.00 $4,800.00
6 Monthly Progress Documentation & Insurance Billing Coordination 6 month $2,500.00 $15,000.00
SUBTOTAL $363,000.00
New York City Sales Tax (8.875%) $32,214.38
TOTAL AMOUNT DUE (USD) $395,214.38

Services under this Purchase Order shall commence on July 1, 2025 and conclude on December 31, 2025. The Occupational Therapist shall provide a minimum of 24 treatment sessions per month across all assigned patients. All in-home visits within United States New York City must be scheduled no fewer than 48 hours in advance. Emergency or urgent-care Occupational Therapist visits may be arranged with 4-hour notice at the discretion of the supervising physician.

  • Payment shall be made within net 30 days from the date of invoice receipt.
  • Invoices shall be submitted electronically to [email protected] by the 5th of each month for the preceding month's services.
  • A late payment penalty of 1.5% per month shall apply to overdue balances.
  • All payments shall be made via ACH transfer to the account designated by the Occupational Therapist provider on file.
  • Disputed charges must be reported in writing within 10 business days of invoice date.
  • The Occupational Therapist shall maintain professional liability insurance with a minimum coverage of $2,000,000 per occurrence, naming the Purchasing Entity as an additional insured.
  • All services must comply with the New York State Education Law, Title 8 NYCRR, and applicable HIPAA regulations governing patient confidentiality in United States New York City.
  • The Occupational Therapist shall submit monthly progress reports detailing patient outcomes, session notes, and any modifications to the treatment plan.
  • Either party may terminate this Purchase Order with 30 days' written notice. In the event of termination, the Purchasing Entity shall pay for all services rendered up to the effective date of termination.
  • The Occupational Therapist shall not subcontract or delegate any portion of the therapeutic services without prior written consent from the Purchasing Entity.
  • This Purchase Order is governed by the laws of the State of New York and the federal laws of the United States. Any disputes shall be resolved through binding arbitration in United States New York City under the rules of the American Arbitration Association.
  • All patient records and clinical documentation generated under this Purchase Order shall remain the property of the Purchasing Entity and shall be retained in accordance with New York State medical record retention statutes.

For the Purchasing Entity:

Dr. Eleanor Whitfield
Director of Clinical Services
Manhattan Community Health & Rehabilitation Center
Date: ______________________

For the Service Provider:

Marcus Delgado, PT, OTR/L
Lead Occupational Therapist
Bronx & Beyond Occupational Therapy Group, LLC
Date: ______________________

This Purchase Order (PO No. NYC-OT-2025-04872) is a legally binding document for the procurement of Occupational Therapist services in United States New York City. Unauthorized reproduction or distribution is prohibited. For questions regarding this Purchase Order, contact the Procurement Office at (212) 555-0147.

© 2025 Manhattan Community Health & Rehabilitation Center – United States New York City, NY

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