Trial Request: Equipment/Product
This form must be completed PRIOR to start of trial usage for any FDA approved product. All trial requests will be presented through Value Analysis for review, discussion and approval.
- All sections of this e-form must be completed. Incomplete forms will be returned.
- Requests may be initiated by any clinical person, however a Physician or Nurse is required to champion all products.
- Product must be provided at NO CHARGE unless other arrangements have been made with Supply Chain Management (SCM). ** FREE product is to never be charged to UTMC patients or their insurance.
- Tracking of product utilization is the responsibility of the clinical team requesting the trial.
- Trial timeframe is either 90 days or a select number of cases (whichever comes first).
- Upon completion of the trial timeframe, evaluation sheets will be completed by clinical team and forwarded to Value Analysis Facilitator (VAF) to be presented at next Value Analysis meeting