CVA Request form
- All sections of this e-form must be completed. Incomplete forms will be returned thus delaying the process.
- Form is to be used for any new or replacement clinical supply item that is an increase over current item and minor equipment with disposable supplies requests.
- Form is NOT to be used for major capital equipment purchases (defined as over $5K capital threshold). See capital equipment process (provide link)
- Cases scheduled without authorization from Supply Chain Management on use of product may be subject to cancellation and or product being invoiced at no charge (cannot then bill for reimbursement creating loss of revenue)
- This form is NOT to be filled out by the vendor rep. They will get a separate form to complete.