Purchase Order Surgeon in Belgium Brussels –Free Word Template Download with AI

1. Parties Involved

Buyer (Issuing Entity)
Organization:	Hôpital Universitaire de Bruxelles (HÜB) — Procurement Division
Address:	Av. Hippocrate 58, 1200 Belgium Brussels, Belgium
VAT No.:	BE 0456.789.123
Contact:	Mme. Catherine Delvaux, Head of Medical Procurement
Email:	[email protected]

Supplier / Service Provider
Organization:	Dr. Marc Van den Berghe, Consultant Surgeon — Independent Medical Practice
Address:	Rue de la Loi 142, 1040 Belgium Brussels, Belgium
VAT No.:	BE 0712.345.678
Contact:	Dr. Marc Van den Berghe, MD, FACS
Email:	[email protected]

2. Purchase Order Summary This Purchase Order is issued by Hôpital Universitaire de Bruxelles to engage the services of a qualified Surgeon for a defined period of surgical consultations, operative procedures, and associated medical supplies. All services and deliveries shall be performed within the jurisdiction of Belgium Brussels, in full compliance with the Belgian Federal Law on Medical Practice (2003) and the regulations of the Belgian Medical Council (Orde van Artsen / Ordre des Médecins). 3. Line Items & Scope of Work

Ref	Description of Goods / Services	Qty	Unit	Unit Price (EUR)	Total (EUR)	Delivery / Due
01	Consultation and pre-operative assessment by the Surgeon (General & Vascular Surgery) at the HÜB operating theatre, Belgium Brussels	45	Sessions	320.00	14,400.00	Jul 2025
02	Elective surgical procedures (laparoscopic cholecystectomy, hernia repair) performed by the Surgeon in the Belgium Brussels surgical suite	12	Procedures	2,850.00	34,200.00	Aug 2025
03	Post-operative follow-up consultations and wound management by the Surgeon	60	Sessions	180.00	10,800.00	Sep 2025
04	Specialized surgical instruments and consumables (laparoscopic trocars, suture kits, haemostatic agents) delivered to Belgium Brussels facility	1	Lot	8,750.00	8,750.00	Jun 2025
05	On-call emergency surgical coverage (24/7 standby) provided by the Surgeon at the Belgium Brussels emergency department	3	Months	4,200.00	12,600.00	Jul–Sep 2025
06	Medical training and mentorship sessions conducted by the Surgeon for junior surgical residents at the Belgium Brussels teaching hospital	8	Workshops	950.00	7,600.00	Aug 2025
Subtotal (EUR)					88,350.00
VAT (21% — Belgian standard rate)					18,553.50
Grand Total (EUR)					106,903.50

4. Terms and Conditions

Governing Law: This Purchase Order shall be governed by and construed in accordance with the laws of the Kingdom of Belgium. Any disputes arising from this agreement shall be subject to the exclusive jurisdiction of the Commercial Court of Belgium Brussels.
Qualifications of the Surgeon: The Surgeon engaged under this Purchase Order must hold a valid Belgian medical licence, be registered with the Belgian Medical Council, and maintain current malpractice insurance with a minimum coverage of EUR 5,000,000 per claim. Proof of credentials shall be submitted prior to the commencement of services.
Place of Performance: All surgical procedures, consultations, and training sessions referenced in this Purchase Order shall take place exclusively at the HÜB facility located in Belgium Brussels, or at such other approved medical site within the Brussels-Capital Region as mutually agreed in writing.
Payment Terms: Invoices shall be submitted monthly. Payment shall be made within 30 calendar days of receipt of a valid invoice, via bank transfer to the account specified by the Surgeon. Late payments shall accrue interest at the rate prescribed by the Belgian Law on Late Payment in Commercial Transactions.
Confidentiality & Data Protection: The Surgeon shall comply with the Belgian Data Protection Act (Law of 30 July 2018) and the EU General Data Protection Regulation (GDPR). All patient records generated during the performance of this Purchase Order shall remain the property of the HÜB and shall not be disclosed to any third party without explicit patient consent.
Quality Assurance: The Surgeon agrees to participate in the Belgium Brussels hospital quality review programme, including morbidity and mortality conferences, and to submit to periodic peer review of surgical outcomes.
Termination: Either party may terminate this Purchase Order with 30 days’ written notice. In the event of termination, the Surgeon shall complete all scheduled procedures already booked and ensure continuity of patient care in accordance with Belgian medical ethics guidelines.
Force Majeure: Neither party shall be liable for failure to perform obligations under this Purchase Order due to events beyond reasonable control, including but not limited to natural disasters, pandemics, or government-mandated closures affecting medical facilities in Belgium Brussels.
Warranty on Supplies: All surgical instruments and consumables delivered under Line Item 04 shall carry a minimum 12-month manufacturer warranty. Defective items shall be replaced at no additional cost within 10 business days of notification.
Anti-Corruption: Both parties warrant that no bribe, kickback, or improper inducement has been offered or accepted in connection with this Purchase Order, in compliance with Belgian anti-corruption legislation and the OECD Anti-Bribery Convention.

5. Acceptance & Signatures By signing below, both parties acknowledge and accept all terms, conditions, and line items set forth in this Purchase Order. The Surgeon confirms readiness to commence services at the designated Belgium Brussels facility on the dates specified. This document constitutes a binding commercial agreement upon execution by both authorized representatives. For the Buyer (HÜB — Belgium Brussels)
Name: Mme. Catherine Delvaux
Title: Head of Medical Procurement
Signature: _________________________
Date: 14 June 2025 For the Supplier (Surgeon)
Name: Dr. Marc Van den Berghe, MD, FACS
Title: Consultant Surgeon
Signature: _________________________
Date: 14 June 2025 ⬇️ Download as DOCX Edit online as DOCX

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