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](/resources/formfile/images/10000/umhc-value-analysis-program-product-evaluation-form-page1.png)
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
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p
p
t
t
a
a
b
b
l
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f
f
o
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r
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u
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_
_
_
_
_
_
_
_
_
_
_
_
_
_
N
N
o
o
t
t
a
a
c
c
c
c
e
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p
p
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a
a
b
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l
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