Purchase Order Psychiatrist in Indonesia Jakarta –Free Word Template Download with AI
Official Procurement Document for Professional Medical Services — Indonesia Jakarta Region
PO-2025-JKT-PSY-0047 1. BUYER INFORMATION (Issuing Entity)Company Details
Company Name: Nusantara Corporate Health Solutions PT
Address: Menara Nusantara, 34th Floor, Jl. Jend. Sudirman Kav. 52-53, SCBD, Jakarta Selatan, Indonesia Jakarta 12190
Tax ID (NPWP): 01.234.567.8-012.000
Contact Person: Sari Kusuma, Procurement Manager
Email: [email protected]
Phone: +62 21 5150 8899
Supplier / Service Provider
Provider Name: Dr. Anindya Prameswari, Sp.KJ (Psychiatrist)
Clinic: Jakarta Mind & Wellness Center
Address: Jl. HR Rasuna Said Kav. 5, Kuningan, Jakarta Selatan, Indonesia Jakarta 12950
Medical License No.: 110/2019/KEMENKES/PSY
Specialty: Clinical Psychiatry, Psychopharmacology, Psychotherapy
Contact: +62 812 3456 7890 | [email protected]
2. Download and customize a professional Purchase Order Psychiatrist Indonesia Jakarta Word template. Perfect for business, legal, and personal use. Editable and ready to boost your productivity. OF SERVICES — Psychiatrist EngagementThis Purchase Order is issued by Nusantara Corporate Health Solutions PT to formally engage the services of a licensed Psychiatrist, Dr. Anindya Prameswari, Sp.KJ, for the provision of comprehensive psychiatric evaluation, diagnosis, and ongoing therapeutic services for the company's employees. All services shall be rendered at the Jakarta Mind & Wellness Center located in Indonesia Jakarta, in full compliance with the Indonesian Ministry of Health regulations (Permenkes No. 28 Tahun 2017) governing psychiatric practice and patient confidentiality. The Psychiatrist shall adhere to the ethical standards set forth by the Indonesian Psychiatric Association (Perhimpunan Dokter Spesialis Kedokteran Jiwa Indonesia / PDSKJI).
3. LINE ITEMS — Services Ordered| No. | Service Description | Quantity | Unit | Unit Price (IDR) | Total (IDR) |
|---|---|---|---|---|---|
| 1 | Initial Psychiatric Consultation & Comprehensive Mental Health Assessment (90 min) | 25 | Sessions | 2,500,000 | 62,500,000 |
| 2 | Follow-up Psychiatric Therapy Session (60 min) — Ongoing Management | 100 | Sessions | 1,800,000 | 180,000,000 |
| 3 | Psychopharmacological Prescription & Medication Monitoring (per patient per month) | 25 | Months | 750,000 | 18,750,000 |
| 4 | Group Psychoeducation Workshop for Employees (3-hour session, max 20 participants) | 4 | Workshops | 5,000,000 | 20,000,000 |
| 5 | Emergency Psychiatric Crisis Intervention & On-Call Availability (24/7, 12 months) | 1 | Annual | 36,000,000 | 36,000,000 |
| 6 | Written Psychiatric Medical Reports & Fitness-for-Work Certifications | 25 | Reports | 500,000 | 12,500,000 |
| 7 | Quarterly Progress Review Meeting with HR Department (Indonesia Jakarta office) | 4 | Meetings | 1,500,000 | 6,000,000 |
| Subtotal: | IDR 335,750,000 |
| VAT (PPN) 11%: | IDR 36,932,500 |
| Service Tax (PPh 23) 2%: | IDR 6,715,000 |
| GRAND TOTAL: | IDR 379,397,500 |
- Scope of Practice: The Psychiatrist shall provide all psychiatric services exclusively at the designated clinic facility in Indonesia Jakarta or via approved telemedicine platforms as mutually agreed. No services shall be delegated to unlicensed personnel.
- Confidentiality: All patient records, psychiatric evaluations, and medical reports shall be treated as strictly confidential in accordance with Indonesian Law No. 36 of 2009 on Health and the Personal Data Protection Law (UU PDP No. 27 of 2022). The Psychiatrist shall not disclose any employee's mental health information to the employer beyond the scope of fitness-for-work certification.
- Service Period: This Purchase Order covers a service period of twelve (12) months commencing 01 July 2025 and expiring 30 June 2026, unless renewed in writing by both parties.
- Payment Schedule: Payment shall be made in quarterly installments within thirty (30) days of receiving a valid tax invoice (faktur pajak) from the Psychiatrist's clinic. Late payments shall incur a penalty of 1% per month.
- Performance Standards: The Psychiatrist shall respond to all employee consultation requests within forty-eight (48) hours and to emergency crisis interventions within two (2) hours. Failure to meet these standards for three consecutive instances shall constitute a material breach of this Purchase Order.
- Regulatory Compliance: The Psychiatrist warrants that all services are delivered in compliance with the Indonesian Ministry of Health (Kementerian Kesehatan RI) regulations, the Indonesian Psychiatric Association (PDSKJI) code of ethics, and all applicable local ordinances in Indonesia Jakarta.
- 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 care for all active patients.
- Governing Law: This Purchase Order shall be governed by and construed in accordance with the laws of the Republic of Indonesia. Any disputes shall be resolved through arbitration at the Indonesian National Board of Arbitration (BANI) in Jakarta.
- Force Majeure: Neither party shall be liable for failure to perform obligations due to natural disasters, government mandates, or public health emergencies affecting Indonesia Jakarta, provided written notice is given within five (5) business days.
For and on behalf of the Buyer:
Nusantara Corporate Health Solutions PT
Sari Kusuma
Procurement Manager
Date: _______________
For and on behalf of the Psychiatrist / Provider:
Jakarta Mind & Wellness Center
Dr. Anindya Prameswari, Sp.KJ
Lead Psychiatrist
Date: _______________
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