Purchase Order Radiologist in United States Houston –Free Word Template Download with AI
Memorial Hermann Medical Group – Radiology Division
6400 Fannin Street, Suite 2100, Houston, Texas 77030, United States
Phone: (713) 555-0142 | Fax: (713) 555-0143 | Email: [email protected]
Purchase Order No. PO-2025-HOU-04872
DATE OF ISSUE: June 12, 2025
DELIVERY/START DATE: July 1, 2025
REQUIRED COMPLETION: June 30, 2025
CURRENCY: United States Dollars (USD)
SHIP-TO / SERVICE LOCATION:
Memorial Hermann – Texas Medical Center
6400 Fannin Street
Houston, Texas 77030
United States
VENDOR / SERVICE PROVIDER INFORMATION| Field | Details |
|---|---|
| Vendor Name | Dr. Elena M. Vasquez, MD, FACR – Independent Radiologist |
| Business Address | 1200 Medical Plaza Drive, Suite 450, Houston, Texas 77030, United States |
| Tax ID / EIN | 75-XXXXXXX |
| License No. | TX Medical License #R-2019-44871 (State of Texas Board of Medical Examiners) |
| Board Certification | American Board of Radiology – Diagnostic Radiology (Certified through 2029) |
| Contact | Dr. Elena M. Vasquez | (713) 555-0298 | [email protected] |
| Item # | Description of Service | Quantity | Unit | Unit Price (USD) | Extended Price (USD) |
|---|---|---|---|---|---|
| 001 | Diagnostic Radiologist reading services – MRI (Magnetic Resonance Imaging) studies, including but not limited to brain, spine, and musculoskeletal imaging. The Radiologist shall provide written reports within 24 hours of image acquisition for all non-emergent cases. | 1,200 | Studies | $185.00 | $222,000.00 |
| 002 | Diagnostic Radiologist reading services – CT (Computed Tomography) scans, including chest, abdomen, pelvis, and head/neck imaging. The Radiologist shall ensure compliance with all American College of Radiology (ACR) reporting standards. | 2,400 | Studies | $145.00 | $348,000.00 |
| 003 | Diagnostic Radiologist reading services – Digital Mammography and Breast Ultrasound. The Radiologist shall maintain dual-reading protocols as required by the Mammography Quality Standards Act (MQSA) for all patients in the United States Houston metropolitan area served by this facility. | 800 | Studies | $165.00 | $132,000.00 |
| 004 | Emergency / After-hours Radiologist on-call coverage. The Radiologist shall be available for urgent image interpretation within 30 minutes of request, 24 hours per day, 7 days per week, for the duration of this Purchase Order term. | 12 | Months | $4,500.00 | $54,000.00 |
| 005 | Consultative Radiologist services – Second opinion reads, multidisciplinary tumor board presentations, and direct physician-to-physician consultations for complex or indeterminate imaging findings at the Houston, United States facility. | 60 | Consults | $350.00 | $21,000.00 |
| 006 | Quality Assurance and Peer Review participation. The Radiologist shall attend monthly QA meetings, participate in peer review of 5% of all reports, and complete continuing medical education (CME) documentation as required by the State of Texas and the Joint Commission. | 12 | Months | $1,200.00 | $14,400.00 |
| SUBTOTAL | $791,400.00 | ||||
| APPLICABLE TAXES (Texas Sales Tax – Exempt as Medical Service) | $0.00 | ||||
| TOTAL PURCHASE ORDER AMOUNT (USD) | $791,400.00 | ||||
1. This Purchase Order constitutes a binding agreement between Memorial Hermann Medical Group (hereinafter "Purchaser") and the undersigned Radiologist (hereinafter "Vendor") for the provision of diagnostic imaging interpretation services at the facility located in Houston, United States. All services shall be rendered in accordance with the standards established by the American College of Radiology (ACR), the Radiological Society of North America (RSNA), and applicable Texas state medical practice regulations.
2. The Radiologist warrants that all reports issued under this Purchase Order shall be accurate, timely, and in full compliance with the Health Insurance Portability and Accountability Act (HIPAA) and all applicable federal and state privacy laws governing patient health information within the United States.
3. Payment Terms: Net 45 days from the date of invoice receipt. Invoices shall be submitted monthly by the 5th business day of the following month. Late payments shall accrue interest at a rate of 1.5% per month. Payment shall be made via ACH transfer to the bank account designated by the Radiologist on file with the Purchaser's accounts payable department in Houston, Texas.
4. The Radiologist shall maintain a minimum of $2,000,000 in professional medical malpractice liability insurance, naming Memorial Hermann Medical Group as an additional insured party. A certificate of insurance shall be provided prior to the commencement of services and renewed annually.
5. This Purchase Order is valid for a period of twelve (12) months from the start date of July 1, 2025, through June 30, 2026. Either party may terminate this agreement with sixty (60) days written notice. Upon termination, the Radiologist shall complete all pending reports within ten (10) business days.
6. The Radiologist acknowledges that all imaging data, patient records, and proprietary information accessed during the performance of this Purchase Order remain the exclusive property of the Purchaser. No data shall be transferred, stored, or processed outside the United States without prior written authorization.
7. Disputes arising under this Purchase Order shall be governed by the laws of the State of Texas and shall be subject to the exclusive jurisdiction of the state and federal courts located in Harris County, Houston, United States.
8. The Radiologist shall comply with all applicable Occupational Safety and Health Administration (OSHA) guidelines, Joint Commission accreditation standards, and any additional institutional policies in effect at the Houston, United States facility at the time of service delivery.
AUTHORIZATION AND ACCEPTANCEBy signing below, the undersigned parties acknowledge and agree to all terms, conditions, and service specifications outlined in this Purchase Order. The Radiologist confirms acceptance of the scope of work, compensation structure, and compliance obligations as stated herein for the provision of services in the Houston, United States region.
FOR THE PURCHASER:
Memorial Hermann Medical Group – Radiology Division
Authorized Signature
Dr. James R. Whitfield, MD – Chief of Radiology
Date: ______________________
FOR THE VENDOR / RADIOLOGIST:
Dr. Elena M. Vasquez, MD, FACR
Authorized Signature
Dr. Elena M. Vasquez, MD – Radiologist
Date: ______________________
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