Purchase Order Speech Therapist in United States Los Angeles –Free Word Template Download with AI
Document Reference: PO-2025-LA-ST-0047
Issued in the United States, State of California, City of Los Angeles
| Purchase Order Number | PO-2025-LA-ST-0047 |
| Date of Issue | June 15, 2025 |
| Required Delivery Date | July 1, 2025 |
| Service Location | Los Angeles, California, United States |
| Currency | USD (United States Dollar) |
| Payment Terms | Net 30 days from invoice date |
| Organization Name | Pacific Coast Pediatric Health Services, LLC |
| Address | 4520 Wilshire Boulevard, Suite 300, Los Angeles, CA 90010, United States |
| Contact Person | Dr. Margaret Chen, Director of Clinical Operations |
| Phone | (213) 555-0187 |
| [email protected] | |
| Tax ID / EIN | 82-4471936 |
| Provider Name | Angel City Speech & Language Therapy Group, Inc. |
| Address | 1200 S. Grand Avenue, Floor 5, Los Angeles, CA 90015, United States |
| Contact Person | Dr. James Whitfield, Lead Speech Therapist and Practice Owner |
| Phone | (323) 555-0243 |
| [email protected] | |
| License Number | CA-SLP-2019-8847 (California Speech-Language Pathology License) |
This Purchase Order authorizes the engagement of a qualified Speech Therapist to provide comprehensive speech-language pathology services to pediatric patients at the Pacific Coast Pediatric Health Services facility in Los Angeles, California, United States. The Speech Therapist shall be a licensed Speech-Language Pathologist (SLP) holding an active California state license and ASHA certification. The services described in this Purchase Order are intended to address articulation disorders, language delays, fluency impairments, voice disorders, and cognitive-communication deficits in children aged 3 through 17 years.
| Item # | Service Description | Qty | Unit Rate (USD) | Total (USD) |
|---|---|---|---|---|
| 1 | Initial Speech Therapist Assessment and Diagnostic Evaluation (per patient) | 40 | $275.00 | $11,000.00 |
| 2 | Individual Speech Therapy Sessions – 50 minutes (per session, Speech Therapist-led) | 480 | $150.00 | $72,000.00 |
| 3 | Group Speech Therapy Sessions – 60 minutes (up to 4 patients, Speech Therapist-led) | 96 | $220.00 | $21,120.00 |
| 4 | Progress Reports and Parent/Caregiver Consultation (per patient, monthly) | 120 | $85.00 | $10,200.00 |
| 5 | Therapeutic Materials, Augmentative Communication Devices, and Assessment Tools | 1 | $4,500.00 | $4,500.00 |
| 6 | Speech Therapist On-Site Supervision and Staff Training (per day) | 12 | $650.00 | $7,800.00 |
| Subtotal | $126,620.00 |
| California Sales Tax (exempt – medical services) | $0.00 |
| Local Los Angeles Municipal Fee (1.5%) | $1,899.30 |
| TOTAL PURCHASE ORDER AMOUNT | $128,519.30 |
- The Speech Therapist engaged under this Purchase Order must maintain a valid California Speech-Language Pathology license and ASHA Certificate of Clinical Competence (CCC-SLP) for the entire duration of the service period.
- All services shall be rendered at the designated facility in Los Angeles, California, United States, or at approved off-site locations within the greater Los Angeles metropolitan area as mutually agreed upon in writing.
- The Speech Therapist shall comply with all applicable federal, state, and local regulations, including but not limited to HIPAA (Health Insurance Portability and Accountability Act), California Confidentiality of Medical Information Act (CMIA), and the Americans with Disabilities Act (ADA).
- Payment shall be processed within thirty (30) calendar days of receipt of a valid invoice. Late payments shall accrue interest at a rate of 1.5% per month as permitted under California Commercial Code Section 2210(d).
- This Purchase Order is valid for a service period of twelve (12) months commencing July 1, 2025, and expiring June 30, 2026, unless terminated earlier by either party with sixty (60) days written notice.
- The Speech Therapist shall submit monthly progress reports detailing patient outcomes, session attendance, and any modifications to treatment plans. These reports are a condition of continued payment under this Purchase Order.
- Any changes to the scope of services, patient volume, or pricing must be documented in a written amendment to this Purchase Order and signed by authorized representatives of both parties.
- This Purchase Order shall be governed by and construed in accordance with the laws of the State of California and the United States of America. Any disputes shall be resolved through binding arbitration in Los Angeles, California, in accordance with the rules of the American Arbitration Association.
- The Speech Therapist shall carry professional liability insurance with a minimum coverage of $2,000,000 per occurrence and shall provide a certificate of insurance upon request.
By signing below, both parties acknowledge and agree to the terms, conditions, and service specifications outlined in this Purchase Order for the engagement of a Speech Therapist in the United States, Los Angeles, California. This document constitutes a binding agreement between the purchasing entity and the service provider.
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For the Purchasing Entity: Signature Name: Dr. Margaret Chen Title: Director of Clinical Operations Organization: Pacific Coast Pediatric Health Services, LLC Date: ____________________ |
For the Service Provider: Signature Name: Dr. James Whitfield Title: Lead Speech Therapist / Owner Organization: Angel City Speech & Language Therapy Group, Inc. Date: ____________________ |
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