Purchase Order Psychiatrist in Canada Montreal –Free Word Template Download with AI
Psychiatrist Professional Services — Canada Montreal
PO-2025-MTL-00472
Organization: Centre Hospitalier Universitaire de Montréal — Department of Mental Health Services
Address: 1051, Boulevard Deschênes, Canada Montreal, Québec H4A 3J7
Attention: Dr. Émile Fortin, Director of Procurement & Clinical Services
Phone: +1 (514) 555-0198 | Email: [email protected]
Business Number (BN): 123456789 RT0001
Practice Name: Clinique de Psychiatrie du Plateau — Dr. Sophie Marchand, M.D., FRCPC
Address: 1847, Avenue du Mont-Royal Est, Canada Montreal, Québec H2G 1Y4
Attention: Dr. Sophie Marchand, Lead Psychiatrist & Practice Owner
Phone: +1 (514) 555-0342 | Email: [email protected]
Quebec Medical License No.: 2019-48271 (Ordre des médecins du Québec)
Psychiatrist Specialty: Adult Psychiatry, Psychopharmacology, Cognitive-Behavioural Therapy
This Purchase Order authorizes the engagement of a licensed Psychiatrist to deliver comprehensive psychiatric evaluation, diagnosis, and ongoing treatment services to patients referred by the Centre Hospitalier Universitaire de Montréal. The Psychiatrist shall operate in full compliance with the Professional Code of Québec, the Canadian Medical Association guidelines, and all applicable federal and provincial health regulations governing the practice of psychiatry in Canada Montreal.
The Psychiatrist is expected to provide in-person consultations at the designated clinic location in Canada Montreal, as well as telepsychiatry sessions where permitted under Québec health privacy legislation (Law 25 and the Personal Health Information Protection Act). All clinical documentation must be maintained in accordance with the standards set by the Ordre des médecins du Québec and the Canadian Institute for Health Information (CIHI).
| Item # | Description of Psychiatrist Service | Qty / Sessions | Unit Rate (CAD) | Subtotal (CAD) |
|---|---|---|---|---|
| 001 | Initial Psychiatric Assessment & Comprehensive Diagnostic Evaluation (90 min) — Psychiatrist-led, including medical history review, mental status examination, and differential diagnosis formulation | 40 | $285.00 | $11,400.00 |
| 002 | Follow-up Psychiatric Consultation & Treatment Plan Review (45 min) — Ongoing Psychiatrist supervision of medication management and therapeutic progress | 120 | $195.00 | $23,400.00 |
| 003 | Psychopharmacology Prescription & Medication Adjustment Session (30 min) — Psychiatrist prescribes, adjusts, or discontinues psychotropic medications with full documentation | 80 | $150.00 | $12,000.00 |
| 004 | Crisis Intervention & Emergency Psychiatric Consultation (as needed, up to 20 sessions) — Psychiatrist on-call availability for acute psychiatric emergencies in Canada Montreal | 20 | $350.00 | $7,000.00 |
| 005 | Interdisciplinary Case Conference Participation (2-hour sessions) — Psychiatrist attends multidisciplinary team meetings with psychologists, social workers, and nurses | 12 | $420.00 | $5,040.00 |
| 006 | Telepsychiatry Remote Consultation (30 min) — Secure video-based Psychiatrist session for patients in rural or underserved areas of the Canada Montreal metropolitan region | 60 | $175.00 | $10,500.00 |
Subtotal: $69,340.00 CAD
Quebec Sales Tax (QST) 5%: $3,467.00 CAD
Grand Total:
$72,807.00 CAD
- Professional Licensure: The Psychiatrist must maintain an active, unrestricted license issued by the Ordre des médecins du Québec throughout the duration of this Purchase Order. Any lapse in licensure shall constitute immediate grounds for termination without penalty to the purchasing entity.
- Compliance with Canadian and Québec Law: All services rendered under this Purchase Order shall comply with the Canadian Medical Association Code of Ethics, the Professional Code of Québec (CQLR c. C-26), the Personal Health Information Protection Act (PHIPA equivalent in Québec — Law 25), and all applicable regulations of the Canadian provincial health authority in Canada Montreal.
- Confidentiality and Data Protection: The Psychiatrist shall safeguard all patient health information in strict accordance with Québec's privacy legislation. No patient records, clinical notes, or diagnostic data shall be disclosed to any third party without written consent, except as mandated by Canadian law.
- Malpractice Insurance: The Psychiatrist shall carry a minimum of $5,000,000 in professional liability (malpractice) insurance, with the purchasing entity named as an additional insured. A certificate of insurance must be provided prior to the commencement of services.
- Service Location: All in-person Psychiatrist consultations shall take place at the clinic address listed in Section 2, located in Canada Montreal, Québec. The Psychiatrist shall ensure the facility meets all accessibility standards under the Canadian Human Rights Act and Québec's accessibility legislation.
- Payment Schedule: Invoices shall be submitted monthly, no later than the 5th business day of the following month. Payment shall be processed within thirty (30) calendar days of receipt of a valid invoice. Late payments shall accrue interest at the rate prescribed by the Canadian federal government for commercial transactions.
- Termination: Either party may terminate this Purchase Order with thirty (30) days' written notice. In the event of termination, the Psychiatrist shall provide a minimum of two (2) weeks of transition support to ensure continuity of patient care and proper transfer of clinical records to a successor Psychiatrist in Canada Montreal.
- Dispute Resolution: Any disputes arising from this Purchase Order shall be resolved through mediation in accordance with the rules of the Canadian Arbitration Association, with proceedings conducted in Canada Montreal, Québec. The governing law shall be the laws of the Province of Québec and the federal laws of Canada applicable therein.
- Performance Standards: The Psychiatrist shall maintain a patient no-show follow-up rate of no more than 15%, respond to urgent clinical referrals within 48 hours, and submit all required clinical documentation to the purchasing entity's electronic health record system within five (5) business days of each session.
- Continuing Education: The Psychiatrist shall complete a minimum of twenty (20) hours of continuing professional development (CPD) annually, as required by the Ordre des médecins du Québec, and shall provide annual proof of compliance to the purchasing entity.
This Purchase Order for Psychiatrist services in Canada Montreal has been reviewed and approved by the undersigned authorized representatives. By signing below, both parties acknowledge and agree to all terms, conditions, and service specifications outlined in this document. This Purchase Order constitutes a binding agreement between the purchasing entity and the Psychiatrist service provider for the duration specified herein.
For the Purchasing Entity:
Centre Hospitalier Universitaire de Montréal
Name: Dr. Émile FortinTitle: Director of Procurement & Clinical Services
Signature: ______________________________
Date: ______________________________
For the Psychiatrist / Service Provider:
Clinique de Psychiatrie du Plateau
Name: Dr. Sophie Marchand, M.D., FRCPCTitle: Lead Psychiatrist & Practice Owner
Signature: ______________________________
Date: ______________________________ ⬇️ Download as DOCX Edit online as DOCX
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