Medical Product Evaluation Form: What a Hospital Value Analysis Request Asks For

A medical product evaluation form is the request a hospital or health system uses to start a value analysis review of a new or replacement product. There is no single national template: the hospitals cited here (UAMS, Atrium Health Wake Forest Baptist and University of Utah Health) each start the request differently, and the review criteria they publish are what the form is built around. Sources were checked on 2026-11-01.

This guide is for the clinician sponsor or the supplier representative who has to fill one in. It covers what the form collects, who completes which part, and which review criteria it has to answer. For what happens inside the committee, see how a value analysis committee approves purchases; for the supplier side of the process, see selling to hospitals.

Short answer

A medical product evaluation form (also called a new product request or value analysis product evaluation form) records who is asking for a product, what the product is, who supplies it, and how it would be used, so a value analysis team can review it. At UAMS the form is split in two, a short form for the clinician and a long form for the vendor representative. Wake Forest Baptist directs requesters to a new product request form on its intranet. The University of Utah Health sends requesters an information packet.

Definition and scope

Hospitals use “value analysis” for a structured review of products and services before they are adopted. Atrium Health Wake Forest Baptist describes its program as an organized approach to determining the value of technology, products and services, and says its teams review requests for evaluation, including possible trials, and the decision to adopt a product or service or not. Its page states that requests can be for a new or for a replacement product. The form is the document that opens that review; it is not the approval.

Who completes which part

The clearest published split is at the University of Arkansas for Medical Sciences (UAMS), whose workflow page describes six steps:

1. A UAMS physician or clinician, called the Sponsor, submits a short form of 10 questions. It collects the Sponsor’s contact information, the name of the product, and the contact information of the vendor representative.
2. The vendor representative receives an email with a link to the long form. UAMS says most product information will likely be auto-populated from the Symplr product library.
3. The Sponsor receives an email to advance or reject the request, and if advancing answers supplemental questions about how the product will be used at UAMS.
4. A Value Analysis Team member checks that the required information was entered, and a specialized team reviews the product details and adds supporting data such as projected financial impact.
5. The Sponsor presents the request at one of the monthly Value Analysis Committee meetings.
6. The committee votes and issues a final decision.

The University of Utah Health also requires a clinician owner. For all surgical-area submissions the physician champion must submit the request. For other departments, the requester sends a New Product Request to the supply chain products and evaluation mailbox, which returns a packet listing what must be submitted, and the requester must obtain a university clinical sponsor. The page tells requesters to follow the packet’s instructions carefully so the process is not slowed down.

What the review asks the form to answer

Wake Forest Baptist publishes the criteria its value analysis teams use. Reading the form as an answer to each criterion is a practical way to prepare it. The table lists the criteria as published; the right-hand column is this guide’s reading of what each one asks of the requester, not wording from the hospital.

Published review criterion	What the requester should be ready to address
Product quality; product effectiveness	Evidence the product does what the request says
Impact on patient outcomes	The expected effect on patients
System impact (one department, the whole system or certain areas)	Where the product would be used
Price, storage requirements, regular availability and packaging	Supplier-provided commercial and logistics details
Contract compliance	How the product relates to existing contracts
Operation and repair criteria	How it is operated and serviced
Benchmark information	Comparison data
Necessary education and training	Who must be trained and how
Safety and OSHA considerations	Safety questions the product raises
Infection control and engineering issues	Input from infection control and engineering
Waste stream and environmental impact	What is discarded and how

Cost questions in these reviews usually extend beyond the purchase price; see the dictionary entry on total cost of ownership for medical equipment, and the entry on group purchasing organizations for the contract context behind the “contract compliance” criterion.

Checklist before you submit

Built from the published pages of UAMS, Wake Forest Baptist and Utah Health, so it is a starting list and not any hospital’s actual form:

• Confirm your institution’s entry point first: an online short form (UAMS), an intranet form (Wake Forest Baptist) or a packet requested by email (Utah Health).
• Line up the clinician sponsor before contacting the value analysis team. Both UAMS and Utah Health require one.
• Give the supplier representative’s name and contact details if the form asks for them; at UAMS the representative completes the second form.
• State whether the request is for a new product or a replacement product.
• Prepare an answer for each published criterion above, especially training, safety, infection control and waste.
• If a trial is part of the request, say so; Wake Forest Baptist states its reviews can include possible trials.

Common misunderstandings

• “There is one standard form.” The three institutions run three different intake routes, so a form completed for one hospital does not transfer to another.
• “Submitting the form means the product is approved.” At UAMS the form only starts a review that ends in a committee vote.
• “The supplier fills in everything.” At UAMS the clinician submits the first form and answers supplemental questions about use; Utah Health requires a clinical sponsor.
• “The form is only about price.” Wake Forest Baptist lists price among twelve review criteria.

FAQ

What is a value analysis product evaluation form?

It is the request that opens a hospital’s value analysis review of a product. Atrium Health Wake Forest Baptist calls it a new product request form and says it covers new and replacement products.

What is a product evaluation form in a hospital?

The name varies. UAMS calls it a New Product Request, split into a short form and a long form; Utah Health uses a New Product Request that returns an information packet.

Who fills out the form, the clinician or the supplier?

At UAMS both: the clinician sponsor submits the short form and the vendor representative submits the long form. At Utah Health a university clinical sponsor is required.

Where do I get the form?

From the hospital’s own supply chain or value analysis page. Wake Forest Baptist points to its intranet forms section; Utah Health asks you to email its products and evaluation mailbox. An intranet form is reachable only from inside that hospital’s network, so ask the value analysis contact for access.

Is there a template I can reuse across hospitals?

The three hospitals cited here do not publish a shared template, and their intake routes differ. Use the criteria checklist above and then the hospital’s own form.

Sources

• UAMS Supply Chain, Workflow for New Product Requests, checked 2026-11-01.
• Atrium Health Wake Forest Baptist, Value Analysis, checked 2026-11-01.
• University of Utah Health Supply Chain, New Products, checked 2026-11-01.

Related reading: supplier risk assessment and the medical equipment sales representative role.