Purchase Order Surgeon in Philippines Manila –Free Word Template Download with AI
St. Augustine Medical Center, Inc.
1200 Quezon Avenue, Diliman, Philippines Manila 1101
Tel: +63 (2) 8921-4455 | Email: [email protected]
Philippine Securities and Exchange Commission Reg. No. CS2019-045678
| Purchase Order No.: | PO-2025-0784-SRG |
| Date of Issue: | June 15, 2025 |
| Required Delivery Date: | July 1, 2025 |
| Payment Terms: | Net 30 Days from Invoice |
| Vendor / Supplier: | Dr. Ricardo M. Villanueva, MD, FACS |
| Specialty: | General and Vascular Surgeon |
| License No.: | PRC-2018-456789 (Philippine Board of Surgery) |
| Address: | Unit 8B, Medical Plaza, Ortigas Center, Philippines Manila 1605 |
This Purchase Order is issued by St. Augustine Medical Center, Inc., a duly registered healthcare institution operating in Philippines Manila, for the procurement of specialized surgical services, surgical instrumentation, and related medical supplies to be rendered by and for the use of a qualified Surgeon. This document serves as the formal authorization for the vendor to provide the items and services enumerated herein in accordance with the terms, conditions, and specifications set forth below. The Purchase Order is governed by the laws of the Republic of the Philippines and shall be interpreted in compliance with the Philippine Medical Technology Act (RA 5527) and the Philippine Code of Medical Ethics.
ITEMS AND SERVICES ORDERED| No. | Description of Item / Service | Qty | Unit | Unit Price (PHP) | Amount (PHP) |
|---|---|---|---|---|---|
| 1 | Consultation and pre-operative assessment by a board-certified Surgeon for elective laparoscopic cholecystectomy procedures (per patient, up to 50 patients) | 50 | Patients | 12,500.00 | 625,000.00 |
| 2 | Surgical procedure: Laparoscopic cholecystectomy performed by the designated Surgeon in the operating theater of St. Augustine Medical Center, Philippines Manila | 50 | Procedures | 85,000.00 | 4,250,000.00 |
| 3 | Post-operative follow-up and wound management by the Surgeon (3 follow-up visits per patient) | 150 | Visits | 3,500.00 | 525,000.00 |
| 4 | Disposable laparoscopic surgical instrument set (trocar, graspers, scissors, clips) – FDA Philippines approved, for use by the Surgeon | 50 | Sets | 18,750.00 | 937,500.00 |
| 5 | Surgical suture materials (absorbable and non-absorbable) and hemostatic agents for the Surgeon's operative procedures | 50 | Packages | 6,200.00 | 310,000.00 |
| 6 | On-call surgical emergency coverage by the Surgeon (24-hour standby, 30-day contract period) | 30 | Days | 15,000.00 | 450,000.00 |
| 7 | Surgical pathology and histopathology laboratory services for tissue specimens collected during the Surgeon's procedures | 50 | Specimens | 4,800.00 | 240,000.00 |
| 8 | Medical waste disposal and biohazardous material handling in compliance with DENR and DOH regulations in Philippines Manila | 50 | Procedures | 1,200.00 | 60,000.00 |
| Subtotal: | PHP 7,397,500.00 |
| VAT (12%): | PHP 887,700.00 |
| Withholding Tax (2%): | (PHP 147,950.00) |
| GRAND TOTAL: | PHP 8,137,250.00 |
- Scope of Services: The Surgeon identified in this Purchase Order shall perform all surgical procedures in strict accordance with the Philippine Board of Surgery standards, the hospital's clinical protocols, and the informed consent of each patient. All services shall be rendered at the St. Augustine Medical Center facility located in Philippines Manila.
- Qualifications: The Surgeon must maintain a valid and active license from the Philippine Board of Surgery, a current Professional Regulation Commission (PRC) certificate, and a valid Medical License from the Philippine Board of Medicine. Proof of malpractice insurance with a minimum coverage of PHP 10,000,000 per occurrence is required prior to the commencement of services.
- Delivery and Performance: All surgical procedures and services outlined in this Purchase Order shall be completed within the timeframe specified. The Surgeon shall report to the operating theater at least thirty (30) minutes prior to the scheduled procedure time. Any delays must be communicated to the hospital's surgical coordinator no later than two (2) hours before the scheduled start time.
- Payment: Payment shall be made within thirty (30) calendar days from the date of receipt of a valid invoice. The Purchase Order number (PO-2025-0784-SRG) must be referenced on all invoices submitted. Payment shall be processed via bank transfer to the account designated by the Surgeon or his authorized representative.
- Compliance with Local Regulations: All activities under this Purchase Order shall comply with the Department of Health (DOH) regulations, the Philippine Food and Drug Administration (FDA) requirements for medical devices, and all applicable municipal ordinances in Philippines Manila. The Surgeon shall ensure that all surgical instruments and consumables are FDA Philippines registered and within their expiration dates.
- Confidentiality: The Surgeon shall maintain strict confidentiality of all patient records and medical information in accordance with the Philippine Data Privacy Act of 2012 (RA 10173). No patient information shall be disclosed to any third party without written consent.
- Termination: Either party may terminate this Purchase Order with a written notice of fifteen (15) days. In the event of termination, the Surgeon shall complete all procedures already scheduled and provide appropriate handover documentation to the hospital's surgical department.
- Dispute Resolution: Any disputes arising from this Purchase Order shall first be resolved through good-faith negotiation. If unresolved, the matter shall be submitted to the Philippine Medical Board or the appropriate court of competent jurisdiction in Philippines Manila.
- Validity: This Purchase Order is valid for a period of ninety (90) days from the date of issue. Any modifications or amendments must be made in writing and signed by both parties.
By signing below, both parties acknowledge that they have read, understood, and agree to all terms and conditions set forth in this Purchase Order. The Surgeon confirms his availability and willingness to perform the services described herein at the designated facility in Philippines Manila.
For: St. Augustine Medical Center, Inc.Maria L. Santos, MD
Chief Medical Officer
Date: ______________________ For: The Surgeon (Vendor)
Ricardo M. Villanueva, MD, FACS
General and Vascular Surgeon
Date: ______________________ ⬇️ Download as DOCX Edit online as DOCX
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