Purchase Order Surgeon in United States San Francisco –Free Word Template Download with AI
Surgeon Professional Services — United States San Francisco
Purchase Order Details
Purchase Order Number: PO-SF-2025-04872
Date of Issue: June 12, 2025
Required Service Date: July 1, 2025
Valid Until: August 15, 2025
Payment Terms: Net 30 Days
Currency: United States Dollars (USD)
Organization: Pacific Coast Medical Center
Address: 1200 Mission Street, Suite 4500, San Francisco, California 94103, United States
Phone: (415) 555-0192
Email: [email protected]
Tax ID / EIN: 94-2837461
Authorized Purchasing Officer: Dr. Margaret Chen, Chief Procurement Officer
Surgeon Name: Dr. James R. Whitfield, M.D., F.A.C.S.
Specialty: General and Minimally Invasive Surgery
Medical License Number: CA-MD-2019-44871
Board Certification: American Board of Surgery (Certified, General Surgery)
Practice Address: 2847 Fillmore Street, San Francisco, California 94115, United States
Phone: (415) 555-0347
Email: [email protected]
NPI Number: 1730482915
Malpractice Insurance Carrier: Medical Mutual Insurance Company, Policy No. MM-2025-88341
This Purchase Order is issued by Pacific Coast Medical Center, located in San Francisco, United States, to engage the services of Dr. James R. Whitfield, a licensed and board-certified Surgeon, for the provision of specialized surgical procedures and related clinical services. This Purchase Order governs the terms, conditions, compensation, and professional obligations associated with the engagement of the Surgeon for the duration specified herein. The Surgeon shall perform all duties in accordance with the standards of care established by the American College of Surgeons and all applicable regulations of the California Medical Board.
| Item # | Description of Service | Quantity | Unit Rate (USD) | Extended Amount (USD) |
|---|---|---|---|---|
| 001 | Laparoscopic Cholecystectomy — Surgeon professional fee, including pre-operative consultation, intra-operative management, and post-operative follow-up visits (up to 3 visits) | 12 procedures | $4,850.00 | $58,200.00 |
| 002 | Open Inguinal Hernia Repair (Bilateral) — Surgeon professional fee, including operative time, anesthesia coordination, and post-operative care | 8 procedures | $6,200.00 | $49,600.00 |
| 003 | Thyroidectomy (Total) — Surgeon professional fee, including pre-operative evaluation, surgical procedure, and post-operative monitoring | 5 procedures | $7,400.00 | $37,000.00 |
| 004 | Emergency Appendectomy — Surgeon on-call professional fee, including after-hours availability and immediate surgical intervention | 6 procedures | $5,100.00 | $30,600.00 |
| 005 | Surgeon On-Call Duty — Monthly retainer for 24/7 availability at Pacific Coast Medical Center, San Francisco, United States (July 2025 through December 2025) | 6 months | $3,500.00 | $21,000.00 |
| 006 | Surgeon Consultation & Second Opinion Services — Inpatient and outpatient consultations for complex surgical cases referred by other departments | 20 consultations | $450.00 | $9,000.00 |
| 007 | Surgeon Training & Mentorship — Supervised surgical training for two (2) resident surgeons in minimally invasive techniques | 2 residents | $2,800.00 | $5,600.00 |
| TOTAL PURCHASE ORDER AMOUNT | $211,000.00 | |||
5.1 This Purchase Order constitutes a binding agreement between Pacific Coast Medical Center (hereinafter referred to as the "Buyer") and Dr. James R. Whitfield, M.D. (hereinafter referred to as the "Surgeon" or "Service Provider") for the provision of surgical and related medical services in San Francisco, United States.
5.2 The Surgeon shall maintain all necessary medical licenses, board certifications, and malpractice insurance coverage throughout the term of this Purchase Order. The Surgeon shall provide proof of current California medical licensure and malpractice insurance upon request.
5.3 All surgical procedures shall be performed in compliance with the Joint Commission standards, California Health and Safety Code, and all applicable federal regulations within the United States.
5.4 The Surgeon shall submit itemized invoices to the Buyer's Accounts Payable department within fifteen (15) business days following the completion of each service period. Payment shall be processed within thirty (30) days of invoice receipt.
5.5 The Surgeon shall maintain complete and accurate medical records for all patients treated under this Purchase Order in accordance with HIPAA regulations and California Confidentiality of Medical Information Act (CMIA).
5.6 Either party may terminate this Purchase Order with thirty (30) days written notice. In the event of termination, the Buyer shall compensate the Surgeon for all services rendered up to the effective date of termination.
5.7 This Purchase Order shall be governed by and construed in accordance with the laws of the State of California, United States. Any disputes arising under this Purchase Order shall be resolved through binding arbitration in San Francisco, California.
5.8 The Surgeon acknowledges that all patient data, surgical records, and proprietary medical information obtained during the course of this engagement shall remain the confidential property of Pacific Coast Medical Center.
All services described in this Purchase Order shall be performed at Pacific Coast Medical Center, 1200 Mission Street, San Francisco, California 94103, United States, or at such other approved facility within the San Francisco Bay Area as mutually agreed upon in writing by both parties. The Surgeon shall report to the designated operating suite no later than thirty (30) minutes prior to the scheduled start time of each procedure.
This Purchase Order has been reviewed and authorized by the undersigned representatives of Pacific Coast Medical Center. By signing below, the Surgeon acknowledges receipt of this Purchase Order and agrees to perform the services described herein in full compliance with all stated terms and conditions.
For Pacific Coast Medical Center (Buyer):
Dr. Margaret Chen, Chief Procurement OfficerDate: ____________________
For the Surgeon (Service Provider):
Dr. James R. Whitfield, M.D., F.A.C.S.Date: ____________________
Note: This Purchase Order is specific to the engagement of the Surgeon for the period of July 1, 2025, through December 31, 2025. Any additional surgical procedures or services beyond the scope outlined in Section 4 shall require a separate Purchase Order amendment approved by both parties. The Surgeon shall comply with all hospital bylaws, infection control protocols, and safety regulations in effect at Pacific Coast Medical Center, San Francisco, United States, at the time of service delivery.
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