Value Analysis Request: Equipment/Product
Instructions for completion:
- Please complete the request in its entirety. Incomplete requests will be returned
- Form is to be used for any new or replacement clinical supply item or minor equipment request.
- This form is NOT intended for major capital equipment requests, but should be used for equipment-related supply items.
- Please email the following supporting documentation to Jennifer Pastorek
- supplier quote including any equipment, disposables or non-disposable accessories
- brochure or catalog picture
- peer review/white papers on patient outcomes/efficacy concerns