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Institutional Value Analysis Program: Forms Library

Product Selection Criteria Document
This document is a guideline to determine where product approval responsibility resides based on contracts, costs, and patient care outcomes.

VACC Cost Analysis Short Form
This form is required for products requested that would replace existing products already in use.

VACC Cost Analysis Long Form
This form is a detailed version of the cost analysis short form. It is required for products requested that include replacement costs for reusable instruments/equipment, labor costs, and procedure costs.

Institutional Value Analysis Request Form
This form is required to request any/all new products that are to be considered for use in the hospital and clinics.

Sole Source Justification Products
This form is required to provide the information necessary for purchasing products for a sole brand and/or sole source.

Capital Equipment Request Form

Vendor Release Form
This form is required when bringing in product, device or equipment for clinical evaluation

Product Complaint Form
This form expedites reporting difficulties with products, assures needed information is documented for follow-up.

Third Column

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