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

1. Scope of Services: This Purchase Order authorizes the contracted Psychologist, Dr. Sarah M. Whitfield, and her affiliated team at Lakeview Psychological Associates, P.C., to provide the clinical psychology services enumerated above at the designated Northshore Behavioral Health Services facility located in Chicago, Illinois, United States. All services must be rendered in accordance with the Illinois Psychology Practice Act (225 ILCS 65) and the ethical standards of the American Psychological Association.
2. Licensure and Compliance: The Psychologist shall maintain an active, unrestricted Illinois psychology license throughout the duration of this Purchase Order. The vendor shall provide proof of licensure, malpractice insurance (minimum $2,000,000 per occurrence), and HIPAA compliance certification prior to the commencement of services. All patient records shall be maintained in accordance with the Health Insurance Portability and Accountability Act (HIPAA) and Illinois personal information protection statutes.
3. Payment Terms: Payment shall be made within thirty (30) calendar days of receipt of a valid invoice. Invoices must reference this Purchase Order number (PO-2025-04872) and include itemized session logs. Payment will be issued via ACH transfer to the vendor's designated business bank account in the United States. Late payments shall accrue interest at 1.5% per month as permitted under Illinois commercial code.
4. Service Location and Scheduling: All in-person services shall be conducted at 1200 N. Michigan Avenue, Chicago, IL 60610, or at such other location within the City of Chicago as mutually agreed in writing. The Psychologist shall adhere to the clinical schedule established by Northshore's Clinical Services Director and provide a minimum of 48 hours' notice for any schedule modifications.
5. Confidentiality and Data Protection: The Psychologist and all associated staff shall execute a Business Associate Agreement (BAA) with Northshore Behavioral Health Services prior to accessing any protected health information. All clinical data generated under this Purchase Order shall be stored on servers located within the United States and shall not be transferred to any foreign jurisdiction without prior written authorization.
6. Termination: Either party may terminate this Purchase Order with thirty (30) days' written notice. In the event of termination, the Psychologist shall complete all sessions already scheduled and provide a comprehensive transition plan for all active patients. Northshore shall pay for all services rendered through the effective date of termination.
7. Governing Law: This Purchase Order shall be governed by and construed in accordance with the laws of the State of Illinois and applicable federal law. Any disputes arising hereunder shall be resolved through binding arbitration in Cook County, Chicago, Illinois, United States, in accordance with the rules of the American Arbitration Association.
8. Insurance and Indemnification: The vendor shall maintain professional liability insurance and general liability insurance throughout the term. The Psychologist shall indemnify and hold harmless Northshore Behavioral Health Services, LLC, its officers, directors, and employees from any claims arising out of the negligent or unauthorized practice of psychology.
9. Non-Assignment: The Psychologist services under this Purchase Order are personal in nature and may not be assigned, subcontracted, or delegated to any other provider without the prior written consent of Northshore's Chief Clinical Officer.

By signing below, the parties acknowledge and agree to all terms, conditions, and service specifications outlined in this Purchase Order for Psychologist services to be delivered in Chicago, Illinois, United States.