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

Purchase Order No.: PO-2025-CH-0472
Date of Issue: June 12, 2025
Valid Until: July 12, 2025 Payment Terms: Net 30 Days
Ship-To / Service Location: United States Chicago, IL
Department: Diagnostic Radiology Authorized By: Dr. Margaret L. Chen, MD
Department Head, Radiology
Cost Center: CC-7741-RAD

Provider Name: Dr. James R. Whitfield, MD, FACR — Independent Radiologist

Practice: Whitfield Diagnostic Radiology Associates, P.C.

Address: 1520 South Michigan Avenue, Floor 12, United States Chicago, Illinois 60605

Telephone: (312) 555-0342 | Fax: (312) 555-0343

Illinois Medical License: 231.009876 | DEA Registration: FW4829103

Board Certification: American Board of Radiology (ABR), Diagnostic Radiology

Tax ID (EIN): 36-2847195

This Purchase Order is issued by Northshore Medical Imaging Group, LLC to engage the services of a qualified Radiologist for the provision of diagnostic imaging interpretation, reporting, and consultation services at our facility located in United States Chicago. The Radiologist shall perform all duties in accordance with the standards established by the American College of Radiology (ACR) and the Illinois Department of Public Health. All services rendered under this Purchase Order shall be conducted at the Northshore Medical Imaging Group facility in United States Chicago or at such other locations within the Chicago metropolitan area as mutually agreed upon in writing.

Item #	Description of Service	Quantity / Duration	Unit Rate (USD)	Extended Amount (USD)
1	Radiologist interpretation and reporting of MRI scans (brain, spine, and musculoskeletal) — per study	1,200 studies	$185.00	$222,000.00
2	Radiologist interpretation and reporting of CT scans (chest, abdomen, pelvis) — per study	950 studies	$145.00	$137,750.00
3	Radiologist interpretation and reporting of conventional X-ray and fluoroscopy — per study	2,400 studies	$65.00	$156,000.00
4	Radiologist interpretation and reporting of ultrasound (abdominal, vascular, obstetric) — per study	600 studies	$120.00	$72,000.00
5	On-call Radiologist coverage for after-hours and weekend emergency imaging at United States Chicago facility	12 months	$4,500.00/mo	$54,000.00
6	Radiologist consultation and second-opinion services for complex or indeterminate cases	150 consultations	$250.00	$37,500.00
7	Radiologist participation in multidisciplinary tumor board meetings (United States Chicago area hospitals)	24 sessions	$350.00	$8,400.00
TOTAL PURCHASE ORDER AMOUNT:				$687,650.00

Scope of Services: The Radiologist identified in this Purchase Order shall provide all diagnostic imaging interpretation, written reports, and clinical consultations as specified in the line items above. All reports must be completed within twenty-four (24) hours of image acquisition for routine studies and within two (2) hours for emergency or STAT studies performed at the United States Chicago facility.
Compliance and Licensure: The Radiologist shall maintain an active, unrestricted Illinois medical license, valid DEA registration, and current ABR board certification throughout the term of this Purchase Order. The Radiologist shall comply with all applicable federal, state, and local regulations governing the practice of radiology in United States Chicago, including but not limited to HIPAA, the Illinois Patient Care and Safety Act, and ACR accreditation standards.
Payment Terms: Invoices shall be submitted monthly on the last business day of each calendar month. Payment shall be made within thirty (30) days of receipt of a valid invoice. Late payments shall accrue interest at a rate of 1.5% per month. All payments shall be made via ACH transfer to the account designated by the Radiologist on file with Northshore Medical Imaging Group, LLC.
Confidentiality and Data Protection: The Radiologist agrees to maintain strict confidentiality of all patient health information in accordance with the Health Insurance Portability and Accountability Act (HIPAA) and the Illinois Personal Information Protection Act. All electronic health records and imaging data shall be stored and transmitted through the secure PACS system provided by Northshore Medical Imaging Group, LLC in United States Chicago.
Malpractice Insurance: The Radiologist shall maintain professional liability (malpractice) insurance with a minimum coverage of $2,000,000 per occurrence and $6,000,000 in the aggregate. A certificate of insurance naming Northshore Medical Imaging Group, LLC as an additional insured shall be provided prior to the commencement of services and upon each annual renewal.
Termination: Either party may terminate this Purchase Order with thirty (30) days written notice. In the event of termination, the Radiologist shall complete all pending studies and deliver final reports within the notice period. All fees for services rendered through the termination date shall be paid in accordance with the payment terms herein.
Governing Law: This Purchase Order shall be governed by and construed in accordance with the laws of the State of Illinois, United States Chicago. Any disputes arising hereunder shall be subject to the exclusive jurisdiction of the state and federal courts located in Cook County, United States Chicago, Illinois.
Independent Contractor Status: The Radiologist is engaged as an independent contractor and not as an employee, agent, or partner of Northshore Medical Imaging Group, LLC. The Radiologist is solely responsible for all federal, state, and local taxes, including self-employment tax, arising from compensation received under this Purchase Order.
Quality Assurance: The Radiologist shall participate in the quality assurance and peer review programs administered by Northshore Medical Imaging Group, LLC. The Radiologist shall attend a minimum of two (2) continuing medical education (CME) sessions per year relevant to diagnostic radiology and shall provide documentation of completion to the Department Head.

By signing below, the undersigned parties acknowledge and agree to all terms, conditions, and service specifications set forth in this Purchase Order for Radiologist services to be performed in United States Chicago. This Purchase Order constitutes a binding agreement between the parties upon execution by both authorized representatives.

For Northshore Medical Imaging Group, LLC (Buyer):

Name: Dr. Margaret L. Chen, MD
Title: Department Head, Diagnostic Radiology
Signature: ___________________________
Date: ___________________________

For Whitfield Diagnostic Radiology Associates, P.C. (Radiologist / Seller):

Name: Dr. James R. Whitfield, MD, FACR
Title: Principal Radiologist
Signature: ___________________________
Date: ___________________________ ⬇️ Download as DOCX Edit online as DOCX

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