Fillable Printable UMHC Value Analysis Program Product Evaluation Form
Fillable Printable UMHC Value Analysis Program Product Evaluation Form
UMHC Value Analysis Program Product Evaluation Form
UMHC
VALUE ANALYSIS PROGRAM
PRODUCT EVALUATION FORM
DATE_____________
PERSON WHO DID THE REVIEW: _________________ ___________________ ____________________
(NAME) (TITLE) (DEPARTMENT)
PRODUCT REVIEWED: _________________________________________________________________
MANUFACTURER AND CAT. NO.:_______________________________________________________
TO BE COMPLETED BY THE PERSON WHO REVIEWED THE PRODUCT:
YES NO
1. Is the package labeling easy to read? O O
2
2
.
.
Does the product open with ease? O O
3. If the product is sterile, can it be opened without jeopardizing the sterility of the contents? O O
4. Does the product contain all the components needed for the procedure to be performed? O O
If no, which additional ones are required?
______________________________________________________________________________________
5. Does this product contain components not needed (excess) for the procedure to be O O
performed? If yes, which ones?
______________________________________________________________________________________
6. Will this product “do the job”? O O
7. What, if any, are the disadvantages of the product? ____________________________________________
______________________________________________________________________________________
8. What characteristics of this product are superior to those of the products now in use? _________________
______________________________________________________________________________________
9. What characteristics of this product are inferior to those of the products now in use? __________________
______________________________________________________________________________________
10. Will there be a change in Hospital Policy and /or Procedure if we use this product? O O
If ye s, explain: __________________________________________________________________________
11. In addition to all the above:
A) Briefly list additional reasons for recommending the use of this product.
____________________________________________________________________________________
B) Briefly list additional reasons for recommending the WE NOT USE this product.
____________________________________________________________________________________
8. Will this product be a patient charge? O O
9.
If yes, can it be combined as a consolidated procedure charge? O O
10. Is yes, into what procedure would y ou place this charge? _______________________________
C
C
H
H
E
E
C
C
K
K
O
O
N
N
E
E
:
:
_
_
_
_
_
_
_
_
_
_
_
_
_
_
A
A
c
c
c
c
e
e
p
p
t
t
a
a
b
b
l
l
e
e
f
f
o
o
r
r
u
u
s
s
e
e
_
_
_
_
_
_
_
_
_
_
_
_
_
_
N
N
o
o
t
t
a
a
c
c
c
c
e
e
p
p
t
t
a
a
b
b
l
l
e
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f
f
o
o
r
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u
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