New/Replacement Clinical Product and Equipment Request Form

JHHS New/Replacement Clinical Product and Equipment Request Form

Instructions for completion:

1. Form is to be used for any new or replacement clinical supply item or minor equipment request.
2. This form is NOT intended for major capital equipment requests, but IS to be used for equipment-related supply items.
3. In order for requests to be considered, please complete entire form. Form must include the name and contact number of a knowledgable and available clinical contact.
4. Forward additional information required to Corporate Purchasing via fax at 410-550-3331, 3332.

Please note: Fields marked with << are required.