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PRODUCT SUBMISSIONS

Health care vendors must use this form to submit information to Novation regarding their new and potentially innovative technology products. It is not necessary that these products be currently available on a Novation contract.

After confirming that the products have been approved by the FDA for use in the United States, we will post the information in the New Medical Technology area of the Novation public Web site, www.novationco.com. Your information will remain on the site for six months.
* denotes a required field

* Your Company's Name:

* Contact Person:
(For internal Novation use only.)

* Contact Phone:
(For internal Novation use only.)

* Contact E-mail:
(For internal Novation use only.)

To ensure delivery of our e-mails, please add techevaluation@novationco.com to your trusted senders list in Microsoft Outlook®. For assistance, contact your IT department.

* Product Category:

* Service Line:
(Select all that apply.)

If "Other", please explain:
(Please limit to 800 characters or less.)

* Product Name:

* Description of features that provide incremental patient care or safety benefit:
(Please limit to 800 characters or less.)

Statement of additional patient benefit:
(Please limit to 800 characters or less.)

Mfg. Product/NDC Number, if available:

* Has the FDA approved this product for sale and use in the United States?
(For internal Novation use only.)
Yes No N/A

If "Yes", enter the PMA, 510(k), NDC or Exempt:

What are competitive products?
(List examples, separating them with commas. Please limit to 800 characters or less.)

* Is this product currently available on a Novation contract?
Yes No

If "Yes", what is the contract number?

List Web site(s) where interested parties can find information specifically about this product:
(Separate each Web site address with a comma. Please limit to 800 characters or less.)

E-mail address to which health care organizations can submit questions or comments:

* Have any peer reviewed clinical trials been published about this product?
Yes No

* Has reimbursement been established for this technology?
Yes No

If "Yes", what is the code?

Please provide organization and contact information of current users of the technology:
(For internal Novation use only. Please limit to 800 characters or less.)

Novation provides this information about health care technology only as a service to VHA and UHC members, product vendors and other interested parties. The posting of such information on this Web site does not constitute any endorsement of the products described here. Individual health care organizations must determine whether these products are appropriate for use in their facilities.