Purchase Order Ophthalmologist in Canada Montreal –Free Word Template Download with AI
PO No.: PO-2025-OMT-0472
Date Issued: June 12, 2025
Valid Until: July 12, 2025
Procurement of Ophthalmologist Professional Services and Diagnostic Equipment
Region: Canada Montreal — Province of Québec
1. Parties Involved
Buyer (Purchasing Entity)
Name: Centre Hospitalier Universitaire de Montréal (CHUM)
Department: Ophthalmology & Visual Sciences Division
Address: 1001, Boulevard Deschênes, Montréal, Québec, Canada H4L 3G5
Contact: Dr. Marie-Claire Tremblay, Procurement Director
Phone: (514) 555-0198
Email: [email protected]
QST No.: Q123456789
Supplier (Service Provider)
Name: Clinique d'Ophtalmologie du Plateau — Dr. Antoine Berger, Ophthalmologist
License No.: OPHT-2019-44782 (Ordre des opticiens-d'optométristes du Québec)
Address: 1450, Avenue du Mont-Royal Est, Montréal, Québec, Canada H2G 1X4
Contact: Dr. Antoine Berger, Lead Ophthalmologist
Phone: (514) 555-0342
Email: [email protected]
QST No.: Q987654321
2. Scope of Purchase Order
This Purchase Order is issued by the Centre Hospitalier Universitaire de Montréal to formally request and authorize the procurement of specialized Ophthalmologist services, diagnostic equipment, and associated consumables. All services and goods referenced herein shall be delivered and performed within the jurisdiction of Canada Montreal, in full compliance with the Québec Health Insurance Act (Loi sur les assurances maladie du Québec), the Canadian Medical Association guidelines, and all applicable federal and provincial regulations governing the practice of ophthalmology in the province of Québec.
3. Line Items — Services and Equipment
| Item # | Description | Category | Qty | Unit Price (CAD) | Total (CAD) |
|---|---|---|---|---|---|
| 001 | Comprehensive Ophthalmologist consultation and diagnostic assessment (per patient session, 45 min) | Professional Service | 120 | $285.00 | $34,200.00 |
| 002 | Advanced retinal imaging and OCT (Optical Coherence Tomography) performed by Ophthalmologist | Diagnostic Service | 85 | $420.00 | $35,700.00 |
| 003 | Cataract surgical procedure (phacoemulsification with intraocular lens implantation) by Ophthalmologist | Surgical Service | 24 | $3,850.00 | $92,400.00 |
| 004 | Laser-assisted vision correction (LASIK) procedure performed by Ophthalmologist | Surgical Service | 18 | $4,200.00 | $75,600.00 |
| 005 | Post-operative follow-up visits by Ophthalmologist (series of 3 visits per patient) | Professional Service | 42 | $150.00 | $6,300.00 |
| 006 | Topographic mapping and corneal analysis equipment (Zeiss Atlas 900) — lease and installation | Equipment | 1 | $18,500.00 | $18,500.00 |
| 007 | Consumable intraocular lenses (IOL) — premium multifocal, per unit | Consumables | 24 | $1,150.00 | $27,600.00 |
| 008 | Specialized ophthalmic surgical instruments and microscopes (annual maintenance contract) | Maintenance | 1 | $12,400.00 | $12,400.00 |
| Subtotal: | $302,700.00 | ||||
| QST (Québec Sales Tax) at 9.975%: | $30,194.34 | ||||
| Grand Total (CAD): | $332,894.34 | ||||
4. Delivery and Performance Schedule
All professional services rendered by the Ophthalmologist shall be performed at the designated facility located in Canada Montreal (specifically at the CHUM Ophthalmology Wing, 1001 Boulevard Deschênes) or at the Clinique d'Ophtalmologie du Plateau as mutually agreed upon in writing. Equipment delivery and installation shall be completed no later than August 15, 2025. Surgical procedures shall be scheduled in coordination with the hospital's operating theatre calendar. The Ophthalmologist shall provide a detailed treatment and scheduling plan within ten (10) business days of the acceptance of this Purchase Order.
5. Terms and Conditions
- 5.1 This Purchase Order is governed by the laws of the Province of Québec and the federal laws of Canada applicable in the territory of Canada Montreal.
- 5.2 The Ophthalmologist shall maintain valid professional liability insurance with a minimum coverage of CAD $5,000,000 per occurrence throughout the duration of this Purchase Order.
- 5.3 Payment terms: Net 45 days from the date of invoice receipt. Invoices shall be submitted in Canadian Dollars (CAD) and must include the QST number of the supplier.
- 5.4 The Ophthalmologist warrants that all services will be performed in accordance with the standards established by the Collège des médecins du Québec and the Canadian Ophthalmological Society.
- 5.5 All patient data and medical records generated under this Purchase Order shall be handled in strict compliance with the Québec Act respecting the protection of personal information in the private sector (Law 25) and the federal Personal Information Protection and Electronic Documents Act (PIPEDA).
- 5.6 The Buyer reserves the right to audit the Ophthalmologist's records, billing practices, and service delivery at any reasonable time upon 48 hours' written notice.
- 5.7 Any disputes arising from this Purchase Order shall be resolved through mediation in Canada Montreal before proceeding to the Superior Court of Québec.
- 5.8 This Purchase Order may be amended only by written addendum signed by both parties. No verbal modifications shall be binding.
- 5.9 The Ophthalmologist shall comply with all health and safety regulations enforced by the Agence de la santé publique du Québec within the Canada Montreal region.
- 5.10 Cancellation policy: The Buyer may cancel individual service line items with 14 days' written notice. Cancellation of the entire Purchase Order requires 30 days' notice and may be subject to a penalty of 10% of the remaining contract value.
6. Acceptance and Authorization
By signing below, both parties acknowledge and agree to the terms, conditions, and line items specified in this Purchase Order. The Ophthalmologist confirms availability to deliver all services within the stipulated timeframe in Canada Montreal. The Buyer confirms that sufficient budget allocation has been authorized for the full amount of this Purchase Order.
For the Buyer:
Centre Hospitalier Universitaire de Montréal
Name: Dr. Marie-Claire TremblayTitle: Procurement Director, Ophthalmology Division
Signature: ___________________________ Date: _______________
For the Supplier (Ophthalmologist):
Clinique d'Ophtalmologie du Plateau
Name: Dr. Antoine Berger, OphthalmologistTitle: Lead Ophthalmologist & Principal
Signature: ___________________________ Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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