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Purchase Order Physiotherapist in United States Chicago –Free Word Template Download with AI

PO Number: PO-CHI-2025-04872

Date of Issue: June 12, 2025

Valid Until: July 12, 2025

Purchasing Party (Buyer)

Organization: Lakeview Rehabilitation & Wellness Center

Address: 1420 N. Michigan Avenue, Suite 800, Chicago, Illinois 60610, United States

Contact Person: Margaret Ellison, Director of Clinical Operations

Email: [email protected]

Phone: (312) 555-0147

Tax ID (EIN): 36-4829175

Supplier / Service Provider (Seller)

Organization: Dr. James A. Whitfield, Licensed Physiotherapist

Address: 2200 W. Diversey Parkway, Suite 310, Chicago, Illinois 60647, United States

Contact Person: Dr. James A. Whitfield, DPT, OCS

Email: [email protected]

Phone: (773) 555-0892

License No.: IL-PT-2019-44871

This Purchase Order is issued by Lakeview Rehabilitation & Wellness Center, a licensed healthcare facility operating in United States Chicago, to formally request and authorize the procurement of specialized Physiotherapist services. The Physiotherapist, Dr. James A. Whitfield, is engaged to provide comprehensive outpatient rehabilitation, manual therapy, and therapeutic exercise programming for patients referred by the purchasing organization. All services rendered under this Purchase Order shall be performed at the designated clinical facility located in United States Chicago, in full compliance with the Illinois Department of Public Health regulations and the standards set forth by the American Physical Therapy Association (APTA).

Item # Service Description Quantity / Sessions Unit Rate (USD) Extended Amount (USD)
001 Initial Physiotherapist Assessment & Treatment Plan Development (per patient referral) 40 patients $185.00 $7,400.00
002 Manual Therapy & Joint Mobilization Sessions (30-minute sessions) 320 sessions $120.00 $38,400.00
003 Therapeutic Exercise & Functional Training Programs (45-minute sessions) 280 sessions $145.00 $40,600.00
004 Post-Surgical Rehabilitation Protocol (orthopedic focus, 6-week program) 25 patients $1,250.00 $31,250.00
005 Electrotherapy & Modalities Application (ultrasound, TENS, IFT) 150 sessions $95.00 $14,250.00
006 Progress Evaluation & Discharge Summary Reporting (per patient) 40 patients $75.00 $3,000.00
007 On-Site Physiotherapist Consultation at Lakeview Facility (Chicago, IL) 12 days $450.00 $5,400.00
Subtotal: $140,300.00
Applicable Sales Tax (Illinois, 10.25%): $14,380.75
TOTAL AMOUNT DUE (USD): $154,680.75
  1. Scope of Services: The Physiotherapist shall deliver all clinical services in accordance with the treatment plans outlined in this Purchase Order. All interventions must adhere to evidence-based practice guidelines recognized by the APTA and the Illinois State Board of Physical Therapy.
  2. Service Location: All services under this Purchase Order shall be rendered at the Lakeview Rehabilitation & Wellness Center facility in United States Chicago, or at such other location within the City of Chicago as mutually agreed upon in writing by both parties.
  3. Payment Terms: Payment shall be made within thirty (30) days of receipt of an itemized invoice. Invoices shall be submitted on a bi-weekly basis. Late payments shall accrue interest at a rate of 1.5% per month as permitted under Illinois commercial law.
  4. Licensing and Insurance: The Physiotherapist must maintain an active Illinois physical therapy license throughout the duration of this Purchase Order. The Physiotherapist shall carry professional liability insurance with a minimum coverage of $2,000,000 per occurrence and $5,000,000 aggregate, naming Lakeview Rehabilitation & Wellness Center as an additional insured party.
  5. Confidentiality: All patient health information handled by the Physiotherapist in connection with this Purchase Order shall be protected in strict compliance with the Health Insurance Portability and Accountability Act (HIPAA) and applicable Illinois privacy statutes.
  6. Performance Standards: The Physiotherapist is expected to maintain a patient satisfaction rating of no less than 90% as measured by quarterly surveys administered by the purchasing organization. Failure to meet this standard for two consecutive quarters shall constitute grounds for termination of this Purchase Order with thirty (30) days written notice.
  7. Termination: Either party may terminate this Purchase Order for material breach upon thirty (30) days written notice. The purchasing party may terminate for convenience upon fifteen (15) days written notice, with payment due for all services rendered through the termination date.
  8. Governing Law: This Purchase Order shall be governed by and construed in accordance with the laws of the State of Illinois, United States. Any disputes arising hereunder shall be resolved through binding arbitration in Chicago, Illinois, in accordance with the rules of the American Arbitration Association.
  9. Force Majeure: Neither party shall be liable for failure to perform obligations under this Purchase Order due to events beyond reasonable control, including but not limited to natural disasters, pandemics, or governmental orders affecting operations in United States Chicago.

Services under this Purchase Order shall commence on July 1, 2025 and continue through December 31, 2025, unless earlier terminated in accordance with Section 4. The Physiotherapist shall be available for on-site consultation at the United States Chicago facility on Tuesdays and Thursdays between the hours of 9:00 AM and 5:00 PM Central Standard Time. All patient sessions shall be scheduled in coordination with the Lakeview clinical scheduling office no fewer than five (5) business days in advance.

By signing below, both parties acknowledge and agree to all terms, conditions, and service specifications set forth in this Purchase Order. This document constitutes a binding agreement for the procurement of Physiotherapist services in United States Chicago as described herein.

For Lakeview Rehabilitation & Wellness Center (Buyer)

Name: Margaret Ellison

Title: Director of Clinical Operations

Signature: ___________________________

Date: ___________________________

For Dr. James A. Whitfield, Physiotherapist (Seller)

Name: James A. Whitfield, DPT, OCS

Title: Licensed Physiotherapist

Signature: ___________________________

Date: ___________________________

This Purchase Order (PO-CHI-2025-04872) was issued by Lakeview Rehabilitation & Wellness Center, Chicago, Illinois, United States. This document is valid only when signed by both authorized representatives. For questions regarding this Purchase Order, contact the Procurement Office at (312) 555-0147 or [email protected]. All services are subject to the Illinois Department of Public Health regulations governing physical therapy practice in the State of Illinois.

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