Get New Product/technology Assessment Request Form ... - Or Manager

Filling out the New Product/Technology Assessment Request Form is an essential step for introducing new medical products or technologies in the surgery department. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it.
2. Begin by filling out the 'Requestor' section, including your name, contact information, and the date of the request.
3. In the 'Product/Technology' fields, specify the name or description of the product or technology you are requesting.
4. Provide the reason for the request. Check relevant options such as 'Improves Quality/Technology', 'Improves Efficiency', 'Improves Cost', or 'Improves Safety'.
5. Describe the product or technology, including its function and any improvements it offers. Attach any related literature that supports your request.
6. Indicate the anticipated annual usage and the specific procedures where the product will be applied.
7. Identify any existing products or technologies that the new request might replace, providing their details in the designated fields.
8. Address any additional implementation costs, such as installation and education costs, and state whether additional space is required.
9. Outline the qualifications needed by a physician to safely use this product or technology.
10. Complete the conflict of interest statement by indicating any proprietary interests or financial support received from the company related to the request.
11. Provide your signature to confirm the accuracy of the information given. An approval signature from the department or section chair is also required.
12. Once all sections are filled, save your changes, and you can download, print, or share the completed form as needed.

Start your request process by completing the New Product/Technology Assessment Request Form online today.