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Purchase Order Surgeon in United States Houston –Free Word Template Download with AI

PO No.: US-HOU-2025-04872

Date of Issue: June 12, 2025

Valid Until: July 12, 2025

Location of Performance: United States Houston, Texas 77002

Buyer (Purchasing Entity)

Organization: Houston Metropolitan Medical Center

Address: 4500 Medical Center Drive, United States Houston, TX 77030

Contact Person: Dr. Margaret Ellison, Chief Procurement Officer

Phone: (713) 555-0142

Email: [email protected]

Tax ID (EIN): 74-2891035

Seller (Service Provider)

Organization: Advanced Surgical Solutions Group, LLC

Address: 1200 Surgical Arts Boulevard, United States Houston, TX 77027

Contact Person: Dr. James R. Whitfield, Lead Surgeon & Principal

Phone: (713) 555-0387

Email: [email protected]

Tax ID (EIN): 74-5672891

This Purchase Order is issued by Houston Metropolitan Medical Center to engage the services of a qualified Surgeon and associated surgical team for the performance of elective and urgent surgical procedures at the facility located in United States Houston, Texas. The Surgeon engaged under this Purchase Order shall be board-certified by the American Board of Surgery, hold an active Texas Medical Board license, and maintain malpractice insurance coverage of no less than $5,000,000 per occurrence. All surgical services referenced in this Purchase Order shall be performed in compliance with the standards set forth by the Joint Commission on Accreditation of Healthcare Organizations (TJC) and applicable Texas state regulations governing surgical practice in the United States Houston metropolitan area.

Item # Description Quantity Unit Unit Price (USD) Extended Price (USD)
001 Lead Surgeon – General & Vascular Surgery Consultation and Pre-Operative Assessment 12 Sessions $1,200.00 $14,400.00
002 Surgeon – Elective Laparoscopic Cholecystectomy (per procedure, including anesthesia coordination) 8 Procedures $4,500.00 $36,000.00
003 Surgeon – Urgent Appendectomy (per procedure, on-call availability 24/7) 4 Procedures $5,200.00 $20,800.00
004 Surgeon – Post-Operative Follow-Up Visits and Wound Management 24 Visits $350.00 $8,400.00
005 Surgeon – Intraoperative Pathology Coordination and Tissue Sample Handling 12 Cases $450.00 $5,400.00
006 Surgeon – Surgical Equipment and Implant Procurement (specialized laparoscopic instruments, sutures, mesh) 1 Lot $18,750.00 $18,750.00
007 Surgeon – On-Call Duty Stipend (30-day coverage, United States Houston facility) 3 Months $3,200.00 $9,600.00
008 Surgeon – Continuing Medical Education and Certification Maintenance Support 1 Annual $2,800.00 $2,800.00
SUBTOTAL $116,150.00
Texas Sales & Use Tax (6.25%) $7,264.38
TOTAL PURCHASE ORDER AMOUNT $123,414.38

All surgical services and deliverables under this Purchase Order shall commence on July 1, 2025 and conclude no later than September 30, 2025. The Surgeon shall report to the operating suites at Houston Metropolitan Medical Center, located in United States Houston, Texas, no later than thirty (30) minutes prior to the scheduled start time of each procedure. Urgent and emergency surgical cases shall be addressed by the Surgeon within two (2) hours of notification, regardless of the time of day. All surgical instruments, implants, and consumables listed in Item 006 shall be delivered to the facility's sterile processing department in United States Houston no fewer than five (5) business days prior to the first scheduled procedure.

Payment for this Purchase Order shall be made in accordance with the following schedule: a thirty percent (30%) advance payment upon execution of this Purchase Order, forty percent (40%) upon completion of all elective surgical procedures, and the remaining thirty percent (30%) upon final acceptance of all post-operative follow-up services and delivery of complete surgical documentation. All payments shall be remitted via wire transfer to the account designated by Advanced Surgical Solutions Group, LLC. Invoices shall be submitted to the Buyer's accounts payable department in United States Houston within fifteen (15) calendar days of service completion. Late payments shall accrue interest at a rate of 1.5% per month as permitted under Texas Business & Commerce Code Section 2412.

  1. This Purchase Order is governed by the laws of the State of Texas and the federal laws of the United States. Any disputes arising from this Purchase Order shall be resolved through binding arbitration in United States Houston, Texas, in accordance with the rules of the American Arbitration Association.
  2. The Surgeon shall maintain, at their own expense, professional liability insurance with a minimum coverage of $5,000,000 per occurrence and $10,000,000 in aggregate. Certificates of insurance shall be provided to the Buyer prior to the commencement of services.
  3. The Surgeon shall comply with all applicable federal and state regulations, including but not limited to HIPAA (Health Insurance Portability and Accountability Act), OSHA standards, and Texas Medical Practice Act provisions applicable to surgical practice in United States Houston.
  4. The Buyer reserves the right to terminate this Purchase Order with thirty (30) days written notice in the event of material breach, failure to maintain required licensure, or any finding of professional misconduct by the Texas Medical Board.
  5. All surgical records, operative reports, and patient documentation generated under this Purchase Order shall be maintained in the medical records system of Houston Metropolitan Medical Center and shall be subject to the facility's records retention policy of a minimum of seven (7) years.
  6. The Surgeon shall not subcontract any portion of the surgical services without prior written consent from the Buyer. Any approved subcontractor must meet the same licensure, insurance, and competency standards as the primary Surgeon.
  7. Force majeure events, including but not limited to natural disasters affecting the United States Houston area, shall excuse timely performance for the duration of the event, provided that written notice is given within forty-eight (48) hours.
  8. This Purchase Order constitutes the entire agreement between the parties regarding the subject matter herein and supersedes all prior negotiations, representations, or agreements, whether written or oral.

By signing below, both parties acknowledge that they have read, understood, and agree to all terms, conditions, and specifications set forth in this Purchase Order. The Surgeon represented by the Seller confirms availability to perform all services as outlined and agrees to the performance schedule within the United States Houston facility. The Buyer confirms authorization of funds and approval of the scope of surgical services described herein.

For the Buyer:

Dr. Margaret Ellison

Chief Procurement Officer

Houston Metropolitan Medical Center

Date: ____________________

For the Seller (Surgeon Representative):

Dr. James R. Whitfield, MD, FACS

Lead Surgeon & Principal

Advanced Surgical Solutions Group, LLC

Date: ____________________

Purchase Order No. US-HOU-2025-04872 | Issued in United States Houston, Texas | Page 1 of 1

This document is a controlled record of Houston Metropolitan Medical Center. Unauthorized reproduction or distribution is prohibited.

Document Classification: Confidential – Procurement | Retention: 7 Years per Texas Health & Safety Code

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