Purchase Order Surgeon in United States Los Angeles –Free Word Template Download with AI
Procurement of Surgeon Professional Services & Surgical Supplies — United States Los Angeles
This Purchase Order is issued by Pacific Coast Medical Group, LLC (hereinafter referred to as the "Purchasing Entity") to Dr. Marcus T. Whitfield, M.D., F.A.C.S. (hereinafter referred to as the "Surgeon" or "Service Provider") for the procurement of specialized surgical services, associated surgical supplies, and post-operative care management. This Purchase Order governs all terms, conditions, deliverables, and financial obligations related to the engagement of the Surgeon for a scheduled series of elective and urgent surgical procedures to be performed at the Purchasing Entity's facility located in Los Angeles, California, United States.
The Surgeon is a board-certified general and minimally invasive surgeon licensed by the California Medical Board (License No. CA-482917) and is in good standing with the American Board of Surgery. All services rendered under this Purchase Order shall comply with the standards established by the Joint Commission, the California Department of Public Health, and all applicable federal regulations within the United States.
| Item No. | Description | Quantity | Unit Price (USD) | Extended Price (USD) |
|---|---|---|---|---|
| 01 | Surgeon professional fee — Laparoscopic cholecystectomy (including pre-operative consultation, intra-operative management, and 48-hour post-operative follow-up) | 12 procedures | $4,850.00 | $58,200.00 |
| 02 | Surgeon professional fee — Elective inguinal hernia repair (open technique), including all intra-operative decision-making and immediate post-operative assessment | 8 procedures | $3,600.00 | $28,800.00 |
| 03 | Surgeon on-call availability and urgent surgical intervention coverage (24/7 standby, minimum 6-hour engagement per activation) | 90 days | $1,200.00 | $108,000.00 |
| 04 | Surgical consumables and disposable instruments (sutures, trocars, laparoscopic ports, hemostatic agents, drapes, and sterile gowns) allocated per procedure | 20 procedure kits | $1,150.00 | $23,000.00 |
| 05 | Surgeon-led post-operative wound care and suture removal visits (scheduled at 7-day and 14-day intervals) | 40 visits | $275.00 | $11,000.00 |
| 06 | Surgeon participation in multidisciplinary tumor board consultations and pre-operative imaging review (CT, MRI, ultrasound interpretation coordination) | 6 sessions | $950.00 | $5,700.00 |
| TOTAL PURCHASE ORDER VALUE | $234,700.00 | |||
- Governing Jurisdiction: This Purchase Order shall be governed by and construed in accordance with the laws of the State of California and the applicable federal laws of the United States. Any disputes arising from this Purchase Order shall be resolved through binding arbitration in Los Angeles, California, in accordance with the rules of the American Arbitration Association.
- Payment Terms: The Purchasing Entity shall remit payment within thirty (30) calendar days of receipt of an itemized invoice from the Surgeon. Payment shall be made via electronic funds transfer (EFT) to the bank account designated by the Surgeon. Late payments shall accrue interest at a rate of 1.5% per month.
- Performance Schedule: All surgical procedures outlined in this Purchase Order shall be performed between July 1, 2025, and August 31, 2025, at the Purchasing Entity's surgical facility in Los Angeles, United States. The Surgeon shall provide a detailed surgical schedule no fewer than fourteen (14) days prior to the commencement of procedures.
- Insurance and Liability: The Surgeon shall maintain, at a minimum, $5,000,000 in professional medical malpractice liability insurance and $2,000,000 in general commercial general liability insurance, with the Purchasing Entity named as an additional insured. Certificates of insurance shall be provided prior to the first procedure.
- Compliance: The Surgeon warrants that all services rendered under this Purchase Order shall comply with the Health Insurance Portability and Accountability Act (HIPAA), the California Confidentiality of Medical Information Act (CMIA), and all applicable United States federal and state healthcare regulations.
- Cancellation and Modification: Either party may cancel or modify this Purchase Order by providing written notice no fewer than ten (10) business days in advance. Cancellations of scheduled procedures less than 72 hours prior to the scheduled date shall be subject to a 50% fee of the applicable line item.
- 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 orders, or labor strikes affecting the Los Angeles metropolitan area.
- Confidentiality: All patient records, surgical reports, and proprietary information exchanged under this Purchase Order shall be treated as strictly confidential and shall not be disclosed to any third party without prior written consent, except as required by United States law.
By signing below, both parties acknowledge that they have read, understood, and agree to all terms and conditions set forth in this Purchase Order. This document constitutes a binding agreement for the procurement of Surgeon services and associated surgical supplies in the United States, specifically within the Los Angeles, California jurisdiction.
For the Purchasing Entity:
Pacific Coast Medical Group, LLC
Authorized Signatory: ______________________________Name: Dr. Elena R. Vasquez, M.D. (Chief Medical Officer)
Date: ______________________________
For the Surgeon / Service Provider:
Dr. Marcus T. Whitfield, M.D., F.A.C.S.
Surgeon Signature: ______________________________Name: Dr. Marcus T. Whitfield, M.D.
Date: ______________________________ ⬇️ Download as DOCX Edit online as DOCX
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