Your Company Name
Ship To / Receiving
Riverside Medical Clinic
Attn: Supply Room / Receiving
200 Health Center Drive
City, State 00000
supplies@riversidemedical.com
+1 (555) 600-0001
200 Health Center Drive
City, State 00000
supplies@riversidemedical.com
+1 (555) 600-0001
Medical Supplier
MedLine Industries
Account #: MED-00789
500 Supply Chain Ave
City, State 00000
orders@medline.com
+1 (555) 700-0002
500 Supply Chain Ave
City, State 00000
orders@medline.com
+1 (555) 700-0002
| Item / Catalog # / Description | Qty | Unit Price | Total |
|---|---|---|---|
|
Nitrile Exam Gloves — Medium (case) Powder-free, 100 count/box, 10 boxes/case |
5 | $48.00 | $240.00 |
|
Surgical Masks — ASTM Level 2 (box) 50 masks per box, fluid resistant, ear loop |
10 | $12.00 | $120.00 |
|
Gauze Pads — 4×4 Sterile (case) 100/box, 10 boxes per case, individually wrapped |
3 | $65.00 | $195.00 |
|
Alcohol Prep Pads — 200 count box 70% isopropyl, medium, 200/box |
8 | $9.50 | $76.00 |
|
IV Saline Bags — 0.9% NaCl 1000mL 12 bags per case — refrigeration not required |
4 | $110.00 | $440.00 |
|
Disposable Syringes — 5mL (box/100) Luer lock, individually sterile wrapped, 100/box |
6 | $28.00 | $168.00 |
Subtotal
$1,239.00
Tax (0%)
$0.00
PO Total
$1,239.00
Shipping & Terms
Deliver to supply room dock — receiving hours 8am–4pm.
Temperature-sensitive items must be flagged on packing slip.
All items must include lot numbers and expiration dates.
Expired or near-expired stock will be refused.
Temperature-sensitive items must be flagged on packing slip.
All items must include lot numbers and expiration dates.
Expired or near-expired stock will be refused.
Payment & Conditions
Payment terms: Net 30 from invoice date.
All invoices must reference this PO number.
Returns for recalled or defective items honored within 30 days.
Substitute items require prior written approval from buyer.
All invoices must reference this PO number.
Returns for recalled or defective items honored within 30 days.
Substitute items require prior written approval from buyer.
Please confirm receipt of this PO and provide expected delivery date. Contact our supply coordinator for any questions. Thank you.
Medical Supply PO FAQ
What does a medical supply PO need to include?
A medical supply PO should include catalog/item numbers, quantities, unit prices, lot numbers, expiration date requirements, delivery address with receiving hours, temperature handling instructions, and any return or substitution policies.
Why are lot numbers important on medical POs?
Lot numbers allow healthcare facilities to trace supplies in case of recalls. Including lot number requirements on the PO ensures the supplier documents them on the packing slip and invoice, enabling quick recall response if needed.
Can I refuse delivery of near-expired medical supplies?
Yes — your PO should specify minimum remaining shelf life (e.g., "minimum 12 months remaining"). If supplies arrive near expiration, document and refuse them, and request credit or replacement.
How should a clinic handle emergency supply orders?
For emergency orders, note "URGENT" on the PO and call the supplier directly. Many medical distributors offer same-day or next-day delivery for critical items. Keep a log of emergency POs for budget review.
Is this medical supply PO template free?
Yes, completely free. No account, no watermark. Edit all fields and click Download PDF.