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Purchase Order Occupational Therapist in United States San Francisco –Free Word Template Download with AI

Bay Area Rehabilitation & Wellness Group, Inc.

1200 Market Street, Suite 450, San Francisco, California 94102, United States

Tel: (415) 555-0187 | Email: [email protected]

PO No. SF-OT-2025-00472

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

Field Details
Provider Name Golden Gate Occupational Therapy Associates, LLC
Address 845 Mission Street, Floor 12, San Francisco, California 94105, United States
License No. CA-OT-2024-88341 (State of California Board of Occupational Therapy)
Contact Person Dr. Elena Vasquez, OTR/L – Lead Occupational Therapist
Phone / Email (415) 555-0234 / [email protected]
Tax ID (EIN) 94-XXXXXXX
Field Details
Department Outpatient Rehabilitation Services – San Francisco Campus
Authorized Purchaser Mr. David Chen, Director of Clinical Procurement
Receiving Location Bay Area Rehabilitation & Wellness Group, 1200 Market Street, San Francisco, CA 94102
Cost Center CC-OT-SF-2025-019

This Purchase Order authorizes the procurement of specialized Occupational Therapist services to be delivered at our San Francisco facility and at designated client residences within the San Francisco Bay Area. The Occupational Therapist shall provide comprehensive evaluation, treatment planning, and hands-on therapeutic interventions for patients recovering from orthopedic injuries, neurological conditions, and age-related functional decline. All services must comply with the regulations set forth by the California Department of Consumer Affairs and the Board of Occupational Therapy, and must be performed within the jurisdiction of United States San Francisco and its immediate metropolitan area.

The contracted Occupational Therapist is expected to maintain a minimum of 32 clinical hours per week, including a minimum of four (4) hours dedicated to documentation, interdisciplinary team meetings, and progress reporting to the supervising physician. The Occupational Therapist shall also participate in quarterly quality assurance reviews conducted by the Bay Area Rehabilitation & Wellness Group clinical governance committee.

Item # Description Qty Unit Unit Price (USD) Extended Price (USD)
1 Initial Occupational Therapist Comprehensive Evaluation (per patient) 120 Session $185.00 $22,200.00
2 Occupational Therapist Individual Treatment Session (45 min) 1,440 Session $145.00 $208,800.00
3 Occupational Therapist Group Therapy Session (up to 6 patients) 96 Session $220.00 $21,120.00
4 Home Visit – Occupational Therapist (San Francisco & Bay Area) 60 Visit $210.00 $12,600.00
5 Adaptive Equipment Assessment & Recommendation (per patient) 80 Assessment $95.00 $7,600.00
6 Quarterly Progress Report & Treatment Plan Revision 4 Quarter $1,500.00 $6,000.00
TOTAL CONTRACT VALUE (USD) $278,320.00

* All prices are exclusive of applicable California state and San Francisco municipal taxes. A 7.25% combined sales tax will be applied to taxable line items as determined by the San Francisco Office of Tax Administration.

  • Payment Terms: Net 30 days from receipt of an approved invoice. Payment shall be made via ACH transfer to the vendor account on file. Late payments shall accrue interest at 1.5% per month as permitted under California Commercial Code Section 2304.
  • Service Period: This Purchase Order covers services rendered from July 1, 2025, through June 30, 2026. The Occupational Therapist must be available on-site at the San Francisco campus from Monday through Friday, 8:00 AM to 5:00 PM, Pacific Time.
  • Compliance: The Occupational Therapist shall maintain current licensure with the State of California, hold valid malpractice insurance with a minimum coverage of $2,000,000 per occurrence, and comply with all HIPAA regulations applicable in the United States San Francisco healthcare district.
  • Termination: Either party may terminate this Purchase Order with thirty (30) days written notice. In the event of termination, the Occupational Therapist shall complete all in-progress patient treatment plans and submit final documentation within fourteen (14) days.
  • Confidentiality: All patient records, clinical data, and proprietary treatment methodologies shall remain the exclusive property of Bay Area Rehabilitation & Wellness Group. The Occupational Therapist agrees to a non-disclosure agreement as attached in Appendix A.
  • Governing Law: This Purchase Order shall be governed by and construed in accordance with the laws of the State of California. Any disputes shall be resolved through binding arbitration in San Francisco, California, in accordance with the rules of the American Arbitration Association.
  • Insurance & Indemnification: The vendor shall indemnify and hold harmless the buyer against any claims arising from the negligent performance of Occupational Therapist services within the United States San Francisco service area.

Services under this Purchase Order shall be delivered at the Bay Area Rehabilitation & Wellness Group facility located at 1200 Market Street, San Francisco, California 94102, and at approved home-visit locations within the City and County of San Francisco. Acceptance of services shall be confirmed by the supervising physician or clinical coordinator within five (5) business days of each monthly service summary. Any discrepancies in service delivery or documentation must be reported in writing to the procurement office within the same timeframe.

Authorized by (Buyer):

David Chen, Director of Clinical Procurement

Bay Area Rehabilitation & Wellness Group, Inc.

Date: ______________________

Accepted by (Vendor):

Dr. Elena Vasquez, OTR/L

Golden Gate Occupational Therapy Associates, LLC

Date: ______________________

This Purchase Order (PO No. SF-OT-2025-00472) is a legally binding document governing the procurement of Occupational Therapist services within United States San Francisco. Unauthorized reproduction or distribution is prohibited. For questions, contact the Procurement Office at (415) 555-0187.

Document Version 1.0 | Generated: June 12, 2025 | Page 1 of 1

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