Purchase Order Surgeon in Peru Lima –Free Word Template Download with AI
Medical Professional Services Procurement — Republic of Peru, Lima Metropolitan Region
Document Reference: PO-PE-LIM-2025-04782
Issuing Entity (Buyer)
Clínica San Rafael de Lima S.A.C.
Av. Javier Prado Este 1250, San Isidro
Lima, Peru — CP 15075
RUC: 20601234567
Contact: [email protected]
Phone: +51 1 445-6789
Supplier / Service Provider
Dr. Alejandro Mendoza Quispe, M.D., FACS
Specialized General Surgeon
Calle Los Álamos 890, Miraflores
Lima, Peru — CP 15073
Colocación Médica N° 123456 (COPESAL)
Contact: [email protected]
Phone: +51 987-654-321
Purchase Order Details
PO Number: PO-PE-LIM-2025-04782
Date of Issue: June 12, 2025
Delivery / Service Start: July 1, 2025
Service Period: 12 months (July 2025 – June 2026)
Payment Terms: Net 30 days from invoice
Currency: Peruvian Sol (PEN / S/)
Department & Authorization
Requesting Department: Surgical Services Division
Prepared By: Lic. Carmen Torres, Procurement Manager
Approved By: Dr. Ricardo Salazar, Chief Medical Officer
Legal Review: Abog. Patricia Huamán, Legal Counsel
Classification: Confidential — Internal Use Only
| Item # | Description of Service | Quantity | Unit | Unit Price (S/) | Total (S/) |
|---|---|---|---|---|---|
| 01 | General Surgeon — Full-time surgical consultation and operative services at Clínica San Rafael de Lima, including laparoscopic, open, and emergency surgical procedures. The Surgeon shall perform a minimum of 15 surgical procedures per month as per the clinical schedule established by the Surgical Services Division. | 12 | Months | 18,500.00 | 222,000.00 |
| 02 | Surgeon On-Call Duty — The Surgeon shall be available for emergency surgical interventions 24/7, including weekends and national holidays in the Lima metropolitan area. This includes standby at the facility or remote availability within 45 minutes of the operating theatre. | 12 | Months | 4,200.00 | 50,400.00 |
| 03 | Surgeon Pre- and Post-Operative Patient Care — Comprehensive management of surgical patients including pre-operative assessments, intra-operative supervision, and post-operative follow-up consultations. The Surgeon shall conduct a minimum of 40 patient consultations per month. | 12 | Months | 3,800.00 | 45,600.00 |
| 04 | Surgeon Medical Training & Mentorship — The Surgeon shall provide monthly training sessions for junior surgical residents and medical staff at the Lima facility, covering advanced surgical techniques, patient safety protocols, and evidence-based surgical practice. | 12 | Sessions | 1,500.00 | 18,000.00 |
| 05 | Surgeon Administrative & Compliance Duties — Completion of surgical reports, medical record documentation, participation in hospital quality assurance committees, and compliance with Peruvian Ministry of Health (MINSA) and OSIPED regulatory requirements applicable to surgical practice in Lima. | 12 | Months | 1,200.00 | 14,400.00 |
Subtotal: S/ 350,400.00
IGV (18% VAT — Peru): S/ 63,072.00
Grand Total: S/ 413,472.00
(Four Hundred Thirteen Thousand Four Hundred Seventy-Two Peruvian Soles and 00/100)
Terms and Conditions of This Purchase Order
- Scope of Engagement: This Purchase Order authorizes the engagement of the named Surgeon to provide specialized surgical services exclusively at the Clínica San Rafael de Lima facility located in the San Isidro district of Lima, Peru. The Surgeon shall not be required to perform services at any other location without prior written amendment to this Purchase Order.
- Licensing and Compliance: The Surgeon warrants that he holds a valid medical license issued by the Peruvian Ministry of Health (MINSA) and maintains an active Colocación Médica registration with COPESAL (Colegio de Especialistas del Perú). The Surgeon shall comply with all regulations governing surgical practice in the Lima metropolitan region, including those established by OSIPED and the local health authority (DIRESA Lima Metropolitana).
- Insurance and Liability: The Surgeon shall maintain professional medical malpractice insurance with a minimum coverage of S/ 500,000.00 per incident, valid throughout the service period. All insurance certificates shall be provided to the issuing entity prior to the commencement of services.
- Payment Schedule: Invoices shall be submitted monthly by the 5th business day for services rendered in the preceding month. Payment shall be processed within 30 calendar days of invoice receipt via bank transfer to the account designated by the Surgeon. Late payments shall accrue interest at the rate established by the Superintendencia de Banca, Seguros y AFP (SBS) of Peru.
- Confidentiality and Patient Data: The Surgeon shall adhere strictly to Peruvian data protection laws (Ley N° 29733 — Ley de Protección de Datos Personales) and the internal confidentiality policies of Clínica San Rafael de Lima. All patient records, surgical reports, and clinical data shall be treated as confidential and shall not be disclosed to third parties without written patient consent.
- Termination: Either party may terminate this Purchase Order with 60 days' written notice. In the event of termination, the Surgeon shall complete all scheduled surgical procedures and patient follow-ups within the notice period. Payment shall be made for all services rendered up to the effective date of termination.
- Governing Law: This Purchase Order shall be governed by and construed in accordance with the civil and commercial laws of the Republic of Peru. Any disputes arising from this Purchase Order shall be resolved through the competent courts of Lima, Peru, or through arbitration at the Centro de Arbitraje y Litigios de la Cámara de Comercio de Lima, at the election of the aggrieved party.
- 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, government-mandated closures, or civil unrest affecting the Lima metropolitan area.
- Amendments: Any modification to this Purchase Order, including changes to the Surgeon's scope of duties, compensation, or service schedule, must be documented in a written addendum signed by both parties.
For the Issuing Entity (Buyer)
Clínica San Rafael de Lima S.A.C.
Dr. Ricardo Salazar
Chief Medical Officer
Date: _______________
For the Surgeon (Service Provider)
Dr. Alejandro Mendoza Quispe, M.D., FACS
Dr. Alejandro Mendoza Quispe
General Surgeon
Date: _______________
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