Purchase Order Surgeon in United States New York City –Free Word Template Download with AI
Surgeon Professional Services Engagement
United States New York City
PURCHASE ORDER DETAILSPurchase Order Number: PO-NYC-2025-07842 Date of Issue: June 12, 2025 Required Service Date: July 15, 2025 Payment Terms: Net 30 Days Currency: United States Dollars (USD) Valid Until: August 12, 2025 |
BUYER INFORMATIONOrganization: Metropolitan General Medical Center Address: 450 Lexington Avenue, New York, NY 10017 United States New York City Contact: Dr. Patricia Whitmore, Chief of Surgery Phone: (212) 555-0147 Email: [email protected] |
PROVIDER / SELLER INFORMATION
Surgeon Name: Dr. Alexander J. Reeves, M.D., F.A.C.S.
Specialty: General and Vascular Surgery
Licenses: New York State Medical License #2847561; Board Certified by the American Board of Surgery
Practice Address: 210 East 68th Street, Suite 1200, New York, NY 10065
United States New York City
Tax ID / EIN: 84-2937461
Phone: (212) 555-0392
Email: [email protected]
This Purchase Order is issued by Metropolitan General Medical Center, a licensed healthcare facility operating in United States New York City, to formally engage the professional surgical services of Dr. Alexander J. Reeves, M.D., F.A.C.S. (hereinafter referred to as the "Surgeon"). This Purchase Order governs the scope, compensation, and conditions under which the Surgeon shall perform surgical procedures at the facility located in United States New York City.
| Item | Description | Qty | Unit Price | Total |
|---|---|---|---|---|
| 1 | Primary Surgical Procedure – Laparoscopic Cholecystectomy (Patient: Confidential, MRN 2025-44871) | 1 | $18,500.00 | $18,500.00 |
| 2 | Pre-Operative Consultation and Patient Assessment (Surgeon to evaluate patient, review imaging, and confirm surgical plan) | 1 | $2,200.00 | $2,200.00 |
| 3 | Post-Operative Follow-Up Visits (Surgeon to conduct three follow-up appointments within 30 days of procedure) | 3 | $850.00 | $2,550.00 |
| 4 | Emergency On-Call Availability (Surgeon to remain available for 72 hours post-procedure for any complications) | 1 | $3,400.00 | $3,400.00 |
| 5 | Surgical Documentation and Medical Record Reporting (Surgeon to provide complete operative notes, pathology coordination, and discharge summary) | 1 | $1,100.00 | $1,100.00 |
| TOTAL AMOUNT DUE: | $27,750.00 | |||
- This Purchase Order constitutes a binding agreement between Metropolitan General Medical Center (Buyer) and Dr. Alexander J. Reeves, M.D. (Surgeon) for the provision of surgical services in United States New York City.
- The Surgeon shall perform all duties in accordance with the standards of care established by the New York State Education Department, the American College of Surgeons, and all applicable federal and state medical regulations governing practice in United States New York City.
- The Surgeon warrants that all professional licenses, board certifications, and malpractice insurance coverage (minimum $5,000,000 per occurrence) shall remain in full force and effect throughout the duration of this Purchase Order.
- Payment shall be remitted via electronic funds transfer (EFT) to the account designated by the Surgeon within thirty (30) calendar days of receipt of a valid invoice referencing this Purchase Order number (PO-NYC-2025-07842).
- The Surgeon shall comply with all HIPAA regulations, New York State medical privacy laws, and the facility's internal data protection policies while operating within United States New York City.
- Any modification, cancellation, or amendment to this Purchase Order must be made in writing and signed by both parties. Verbal agreements shall not be enforceable.
- In the event of a dispute arising from this Purchase Order, both parties agree to first attempt resolution through mediation in United States New York City before pursuing litigation in the New York State Supreme Court, New York County.
- The Surgeon shall not subcontract or delegate any portion of the surgical procedure to another physician without prior written consent from the Buyer.
- This Purchase Order is governed by the laws of the State of New York and the United States of America.
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Authorized by (Buyer): Dr. Patricia Whitmore, M.D. Chief of Surgery, Metropolitan General Medical Center Date: ______________________ |
Accepted by (Surgeon): Dr. Alexander J. Reeves, M.D., F.A.C.S. Surgeon, Reeves Surgical Associates Date: ______________________ |
NOTICE: This Purchase Order is a confidential business document pertaining to medical services rendered in United States New York City. Unauthorized reproduction or distribution is prohibited. All patient information referenced herein is protected under HIPAA (45 CFR Parts 160 and 164) and New York State Public Health Law Article 27-F. This document does not constitute a guarantee of surgical outcomes. The Surgeon's professional judgment regarding the procedure remains independent and is not subject to the Buyer's clinical direction.
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