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Purchase Order Ophthalmologist in Australia Brisbane –Free Word Template Download with AI

ABN: 48 217 654 321 | ACN: 612 345 678

Level 12, 400 George Street, Brisbane, Queensland 4000, Australia

Phone: +61 7 3210 4567 | Email: [email protected]

Purchase Order

Purchase Order Details

PO Number: PO-2025-BNE-00487

Date of Issue: 14 June 2025

Required Delivery Date: 30 June 2025

Payment Terms: Net 30 Days

Currency: Australian Dollar (AUD)

Location of Service: Brisbane, Queensland, Australia

Supplier / Ophthalmologist Provider

Name: Dr. Eleanor M. Whitfield, FRANZCO

Practice: Brisbane Advanced Ophthalmology Centre

Address: Suite 5, Level 3, 188 Creek Street, Brisbane, QLD 4000, Australia

AHPRA Registration: 12345678901

ABN: 52 987 654 321

Contact: +61 7 3221 8900 | [email protected]

Bill To

Queensland Vision Health Group Pty Ltd

Level 12, 400 George Street

Brisbane, Queensland 4000, Australia

Attn: Procurement Manager, Mr. David Chen

Ship To / Service Location

QVHG Ophthalmology Clinic

220 Ann Street, Fortitude Valley

Brisbane, Queensland 4006, Australia

Attn: Clinical Operations Director, Dr. Sarah Nguyen

# Description of Ophthalmology Service / Item Quantity Unit Price (AUD) Total (AUD) Delivery / Service Date
1 Comprehensive Ophthalmologist Consultation – Full Diagnostic Eye Examination including OCT, Visual Field Testing, and Fundus Photography for 50 patients 50 $285.00 $14,250.00 16 June – 28 June 2025
2 Cataract Surgery – Phacoemulsification with Premium IOL Implantation (performed by Ophthalmologist Dr. Whitfield) for 12 patients 12 $4,850.00 $58,200.00 23 June – 27 June 2025
3 Retinal Laser Photocoagulation Treatment – Ophthalmologist-administered for 8 patients with diabetic retinopathy 8 $1,240.00 $9,920.00 20 June – 26 June 2025
4 Anterior Segment OCT and Biometry Device (Lenstar 900) – Supply, Installation, and Calibration at Brisbane clinic 1 $32,500.00 $32,500.00 By 30 June 2025
5 Post-Operative Ophthalmologist Follow-Up Visits – 3 visits per cataract patient (Day 1, Week 1, Month 1) 36 $150.00 $5,400.00 24 June – 27 July 2025
6 Specialised Ophthalmic Consumables – IOLs (Alcon PanOptix), Viscoelastic Agents, and Surgical Sutures for 12 cataract procedures 12 $1,875.00 $22,500.00 By 20 June 2025
7 Continuing Professional Development – Ophthalmologist-led Workshop on Advanced Glaucoma Management for QVHG clinical staff (Brisbane venue) 1 $3,200.00 $3,200.00 29 June 2025

Subtotal: $145,970.00 AUD

GST (10%): $14,597.00 AUD

Grand Total: $160,567.00 AUD

Terms and Conditions

  1. This Purchase Order is issued by Queensland Vision Health Group Pty Ltd for the procurement of ophthalmology services and equipment from the named Ophthalmologist provider. All services shall be rendered in accordance with the standards set by the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) and the Australian Health Practitioner Regulation Agency (AHPRA).
  2. All clinical services described in this Purchase Order shall be performed at the designated service location in Brisbane, Queensland, Australia, unless otherwise agreed in writing by both parties. The Ophthalmologist shall ensure that all procedures comply with the Privacy Act 1988 (Cth) and the Australian Privacy Principles.
  3. Payment shall be made within thirty (30) calendar days of receipt of a valid tax invoice from the Ophthalmologist provider. Payment shall be made via electronic funds transfer (EFT) to the bank account nominated by the supplier. All amounts are quoted in Australian Dollars (AUD) and are inclusive of applicable Goods and Services Tax (GST) as registered under the Australian Taxation Office.
  4. The Ophthalmologist warrants that all surgical and diagnostic procedures listed in this Purchase Order shall be performed in a manner consistent with the standard of care expected of a reasonably competent ophthalmologist practising in Australia Brisbane. Any deviation from the agreed clinical protocol must be communicated to the Procurement Manager prior to execution.
  5. Equipment items (Line Item 4) shall be delivered, installed, and calibrated at the Brisbane clinic premises. The Ophthalmologist provider shall provide a minimum of two (2) years of manufacturer warranty and on-site technical support for the duration of the warranty period. All equipment must comply with the Therapeutic Goods Act 1989 (Cth) and be registered with the Therapeutic Goods Administration (TGA).
  6. Cancellation or modification of this Purchase Order may only be made in writing by mutual agreement. Cancellation of scheduled surgical procedures more than 72 hours prior to the procedure date shall incur no penalty. Cancellation within 72 hours shall be subject to a 50% fee on the applicable line item.
  7. This Purchase Order is governed by the laws of the State of Queensland and the Commonwealth of Australia. Any disputes arising from this Purchase Order shall be resolved in the courts of Brisbane, Queensland, Australia. Both parties agree to attempt mediation through the Queensland Small Claims Commission before initiating litigation.
  8. The Ophthalmologist shall maintain valid professional indemnity insurance with a minimum coverage of AUD $10,000,000 per claim throughout the term of this Purchase Order. A certificate of insurance shall be provided to QVHG prior to the commencement of services.
  9. All patient records, clinical data, and diagnostic imaging generated under this Purchase Order shall remain the property of Queensland Vision Health Group Pty Ltd. The Ophthalmologist shall comply with all data retention and security obligations under Australian health information legislation.
  10. This Purchase Order is valid for a period of ninety (90) days from the date of issue. Failure to accept this Purchase Order within the validity period shall render it null and void.

Authorised by (Buyer):

Mr. David Chen

Procurement Manager

Queensland Vision Health Group Pty Ltd

Brisbane, Queensland, Australia

Signature: ___________________________

Date: ___________________________

Accepted by (Ophthalmologist / Supplier):

Dr. Eleanor M. Whitfield, FRANZCO

Brisbane Advanced Ophthalmology Centre

Brisbane, Queensland, Australia

Signature: ___________________________

Date: ___________________________

This Purchase Order (PO-2025-BNE-00487) is a legally binding document issued in Brisbane, Queensland, Australia. It governs the procurement of ophthalmology services and equipment between Queensland Vision Health Group Pty Ltd and the named Ophthalmologist provider. All references to Australia Brisbane in this document pertain to the geographic jurisdiction and service delivery location within the City of Brisbane, Queensland, Australia. For queries, contact the Procurement Department at [email protected] or +61 7 3210 4567.

© 2025 Queensland Vision Health Group Pty Ltd. All rights reserved. Document reference: PO-2025-BNE-00487 | Version 1.0

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