Purchase Order Ophthalmologist in Philippines Manila –Free Word Template Download with AI
Official Procurement Document – Republic of the Philippines
Issuing Organization:Manila Regional Health Authority |
Purchase Order No.: PO-2025-OPH-0047 Date of Issue: June 15, 2025 Due Date: July 15, 2025 Payment Terms: Net 30 Days Currency: Philippine Peso (PHP) |
Vendor / Service Provider Information
Provider Name: Dr. Maria L. Santos, MD, FACS – Board-Certified Ophthalmologist
Practice Name: Manila Vision & Eye Care Center
Address: 45th Floor, The Atrium Tower, 8888 Ayala Avenue, Makati City, Philippines Manila, 1200
License No.: PRC-OPH-2019-00342
TIN: 201-456-789-000
Contact: +63 (2) 8881-7733 | [email protected]
| Item # | Description of Service / Item | Qty | Unit Price (PHP) | Amount (PHP) |
|---|---|---|---|---|
| 001 | Comprehensive Ophthalmologist Consultation and Diagnostic Eye Examination (per patient session, including visual acuity testing, intraocular pressure measurement, and retinal assessment) | 150 | 2,500.00 | 375,000.00 |
| 002 | Ophthalmologist-Performed Phacoemulsification Cataract Surgery with Intraocular Lens Implantation (including pre-operative and post-operative care) | 40 | 45,000.00 | 1,800,000.00 |
| 003 | Ophthalmologist Supervised Anti-VEGF Intravitreal Injection Therapy for Diabetic Retinopathy (per injection session) | 120 | 18,500.00 | 2,220,000.00 |
| 004 | Ophthalmologist-Performed Diagnostic OCT (Optical Coherence Tomography) and Fundus Fluorescein Angiography (per patient) | 200 | 3,200.00 | 640,000.00 |
| 005 | Ophthalmologist On-Call Emergency Eye Care Coverage – Philippines Manila Metro Area (24/7 standby, 6-month contract period) | 6 | 85,000.00 | 510,000.00 |
| 006 | Ophthalmologist-Led Community Eye Screening Program – Philippines Manila Public Schools (including portable equipment, trained technicians, and follow-up referrals) | 12 | 35,000.00 | 420,000.00 |
| Subtotal | PHP 5,965,000.00 |
| VAT (12%) | PHP 715,800.00 |
| TOTAL AMOUNT DUE | PHP 6,680,800.00 |
- This Purchase Order is issued by the Manila Regional Health Authority and governs the procurement of Ophthalmologist professional services and related ophthalmic supplies to be rendered within the Philippines Manila metropolitan area.
- The Ophthalmologist, Dr. Maria L. Santos, MD, FACS, shall perform all services in strict compliance with the Philippine Medical Act (Republic Act No. 2382), the Philippine Ophthalmological Society standards, and all applicable regulations of the Philippine Board of Medicine.
- All services under this Purchase Order shall be delivered at the Manila Vision & Eye Care Center facility located in Philippines Manila, or at such other approved sites within the Philippines Manila metro area as mutually agreed upon in writing.
- The Ophthalmologist shall maintain valid professional liability insurance with a minimum coverage of PHP 10,000,000 per occurrence throughout the duration of this Purchase Order.
- Payment shall be processed within thirty (30) calendar days from the date of receipt of a valid Official Receipt and supporting documentation, in accordance with the Philippine Government Accounting Standards.
- Any modification, cancellation, or amendment to this Purchase Order must be made in writing and signed by both parties. Verbal agreements regarding scope changes to the Ophthalmologist services are not binding.
- The Ophthalmologist shall submit monthly progress reports detailing the number of patients treated, procedures performed, and any complications encountered, to be filed with the Manila Regional Health Authority procurement office in Philippines Manila.
- All patient records and medical data generated under this Purchase Order shall be handled in compliance with the Philippine Data Privacy Act of 2012 (Republic Act No. 10173).
- This Purchase Order is valid for a period of twelve (12) months from the date of issue, unless terminated earlier by mutual written consent or for cause as defined under Philippine contract law.
- Disputes arising from this Purchase Order shall be resolved through mediation in accordance with the rules of the Philippine Dispute Resolution Center, with venue set in Philippines Manila.
|
Authorized by (Issuing Organization):
Engr. Roberto D. Villanueva Date: ____________________ |
Accepted by (Ophthalmologist / Vendor):
Dr. Maria L. Santos, MD, FACS Date: ____________________ |
NOTE: This Purchase Order document is an official procurement instrument of the Manila Regional Health Authority. All transactions are subject to audit by the Commission on Audit (COA) of the Republic of the Philippines. The Ophthalmologist services described herein are exclusively for the benefit of patients residing in or seeking care within the Philippines Manila jurisdiction. Unauthorized reproduction or distribution of this Purchase Order is prohibited under Philippine law.
Purchase Order No. PO-2025-OPH-0047 | Page 1 of 1 | Manila Regional Health Authority – Philippines Manila
Document generated in compliance with Philippine Government Procurement Reform Act (RA 9184)
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