A standardized new product request form helps centralize data. Use these sample questions to tailor a form specific to your health system.
Product/Supplier Information
Name of product requested
Manufacturer
Catalog number(s)
Sales rep name
Sales rep contact information
Price, if known
How did you hear about the product?
Do you or any immediate family members have any financial relationships or other conflicts of interest with the manufacturer, rep, or distributor of this product?
Need Description
What is the clinical justification behind the new product request?
What is the medical literature supporting your clinical justification?
How will this product improve patient care?
Why is this product necessary?
Clinical Reasoning
What is the clinical justification behind the new product request?
What is the medical literature supporting your clinical justification?
How will this product improve patient care?
Why is this product necessary?
Operational Information
What do you expect the annual usage to be/estimated annual procedure volume?
If approved, would there need to be a change to hospital policy/procedure surrounding use?
Are other clinicians/departments interested in using this product?
Would the new product introduction impact other departments?
Is this a request for a trial, purchase, or consignment?
Would staff education need to occur with the product’s approval?
