HTML Preview New Product And Trial Form page number 1.


Ward/Department:
Specialty:
Contract Ref if Applicable:
Proposer: Proposer Signature:
Present Product:
Proposed Product:
Reason for change
(to include details of any quality implications)
:
Fit for Purpose: Yes No
Product requested is Latex free: Yes No NA
Suitable Packaging (e.g. size, easy to open etc):
Ease of Use:
Please give specific reasons/details for any negative responses:
Estimated use per annum:
Cost implications:
Estimated Cost Increase per Annum: £
Estimated Cost Savings per Annum: £
Signature from Head of Department/General Manager or
Nurse Manager:
--------------------------------------------------------- Date:
Signature from Finance
----------------------------------------------------- Date:
Now return to Procurement Department, Cairnsmore East, Crichton Hall
PROPOSAL FOR NEW PRODUCT/TRIAL FORM
(
Please com
p
lete in ca
p
itals
)
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