Purchase Order Psychiatrist in Canada Toronto –Free Word Template Download with AI

Purchase Order No.: PO-2025-04872
Date of Issue: June 12, 2025
Required By: July 1, 2025 Vendor / Service Provider:
Dr. Elena Marchetti, MD, FRCPC
Psychiatrist – Independent Practice
1450 Yonge Street, Suite 802
Toronto, Ontario, Canada M4W 1V8
College of Physicians and Surgeons of Ontario (CPSO) Reg. No.: 48291 Department: Employee Wellness Program
Cost Centre: CC-7741
Payment Terms: Net 30 Days
Currency: Canadian Dollars (CAD)

This Purchase Order is issued by Northlake Health & Wellness Group Inc. to engage the services of a licensed Psychiatrist operating in Canada Toronto for the provision of comprehensive mental health assessment, diagnosis, and treatment services to eligible employees and their dependents under the corporate wellness benefit plan. The selected Psychiatrist, Dr. Elena Marchetti, holds full active registration with the College of Physicians and Surgeons of Ontario and maintains a private practice in the City of Toronto, Ontario, Canada.

Item #	Description	Qty	Unit	Unit Price (CAD)	Amount (CAD)
1	Initial comprehensive psychiatric evaluation and diagnostic assessment (90-minute session) – Psychiatrist, Toronto, Canada	12	Session	$320.00	$3,840.00
2	Follow-up psychiatric consultation and treatment plan review (45-minute session)	36	Session	$210.00	$7,560.00
3	Psychopharmacological management and medication monitoring (30-minute session)	24	Session	$175.00	$4,200.00
4	Psychiatric second-opinion review of existing treatment records	6	Review	$250.00	$1,500.00
5	Written clinical summary and fitness-for-work assessment report	12	Report	$150.00	$1,800.00
6	Urgent psychiatric crisis intervention (after-hours, Toronto, Canada)	4	Session	$400.00	$1,600.00
Subtotal (CAD)					$20,500.00
HST (13% – Ontario, Canada)					$2,665.00
TOTAL AMOUNT DUE (CAD)					$23,165.00

1. Scope of Services: The Psychiatrist shall provide all services listed above in accordance with the standards of practice established by the College of Physicians and Surgeons of Ontario. All consultations shall take place at the Psychiatrist's office located in Toronto, Canada, or via secure telehealth platforms approved by the College.
2. Compliance and Regulation: The Psychiatrist agrees to comply with all applicable federal and provincial legislation in Canada, including but not limited to the Personal Information Protection and Electronic Documents Act (PIPEDA), the Health Information Protection Act (HIPA) of Ontario, and the Ontario Health Professions Act. All patient records generated in Toronto, Canada, shall be stored in compliance with provincial health information privacy regulations.
3. Confidentiality: All clinical information, diagnostic findings, and treatment records pertaining to employees shall be treated with the strictest confidentiality. The Psychiatrist shall not disclose any patient information to Northlake Health & Wellness Group Inc. beyond the scope of the written clinical summary specified in Line Item 5, and only with the patient's explicit written consent.
4. Payment Terms: Payment for this Purchase Order shall be made within thirty (30) calendar days of receipt of a valid tax invoice from the Psychiatrist's practice. Payment shall be processed via electronic funds transfer (EFT) to the bank account designated by the vendor. All amounts are denominated in Canadian Dollars (CAD).
5. Cancellation and Rescheduling: Appointments may be rescheduled with a minimum of 24 hours' notice. Cancellations made with less than 24 hours' notice shall be billed at 50% of the applicable session fee. The total value of this Purchase Order is a maximum commitment; unused sessions shall not be invoiced.
6. Insurance and Liability: The Psychiatrist shall maintain professional liability insurance with a minimum coverage of $5,000,000 per occurrence, as is standard practice for medical professionals in Canada Toronto. A certificate of insurance shall be provided upon request.
7. Termination: Either party may terminate this Purchase Order agreement with thirty (30) days' written notice. Upon termination, the Psychiatrist shall complete all sessions already scheduled and provide a final clinical summary for each patient under active care.
8. Governing Law: This Purchase Order shall be governed by and construed in accordance with the laws of the Province of Ontario and the federal laws of Canada applicable therein. Any disputes arising from this agreement shall be subject to the exclusive jurisdiction of the courts of the Province of Ontario, with venue in the City of Toronto, Canada.
9. Non-Exclusive Engagement: This Purchase Order does not constitute an exclusive arrangement. The Psychiatrist retains the right to provide services to other clients and organizations in Toronto, Canada, provided that no conflict of interest arises with respect to Northlake Health & Wellness Group Inc. employees.
10. Record Retention: In accordance with Ontario medical record-keeping requirements, the Psychiatrist shall retain all clinical records for a minimum of ten (10) years following the last entry. Upon request and with patient consent, copies of records may be provided to the employer for administrative purposes only.

By signing below, the authorized representatives of both parties acknowledge and agree to the terms, conditions, and service specifications outlined in this Purchase Order for the engagement of a Psychiatrist in Canada Toronto.

For Northlake Health & Wellness Group Inc. (Buyer):

Name: Margaret Chen
Title: Director of Human Resources
Signature: _________________________
Date: _________________________

For Dr. Elena Marchetti, MD, FRCPC (Vendor / Psychiatrist):

Name: Dr. Elena Marchetti
Title: Psychiatrist, Independent Practice
Signature: _________________________
Date: _________________________ ⬇️ Download as DOCX Edit online as DOCX

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