Innovative Technology

Submit Products

Health care vendors must use this form to submit information to Vizient regarding their potentially innovative technology products.

Complete this form if you would like your product information posted on the Innovative Technology Online Forum and / or considered for an Innovative Technology Contract.

Once the completed form is received by Vizient, you will receive an email containing

a Record ID number for your technology submission
instructions on how to request an innovative technology contract review

Contact First Name:	Contact Last Name:
Contact Phone:	Contact Fax:
Contact Email:	Company Name:

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

Product Name:

Product Category:

Service Line (select all that apply):

If "Other", please explain:

Please limit to 800 characters or less.

List the competitive or alternatives to your product:

List examples, separating them with commas. Please limit to 800 characters or less.

Is this product currently available on a Vizient contract?
Yes No

If "Yes", what is the contract number?

Mfg. Product/NDC Number, if available:

Has the FDA approved this product for sale and use in the United States?
Yes No N/A

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

Has reimbursement been established for this product?
Yes No N/A

If "Yes", what is the code?

Have any peer reviewed clinical trials been published about this product?
Yes No N/A

Description of the innovative technology features of this product:

Please limit to 800 characters or less.

Explanation of the incremental patient care or safety benefit of this technology:

Please limit to 800 characters or less.

Please provide organization and contact information of current users of the technology:

Please limit to 800 characters or less.

List Web site(s) where interested parties can find information specifically about this product:

List examples, separating each with a comma. Please limit to 800 characters or less.

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

Vizient shares this information, which is provided by the vendor, about health care technology only as a service to members and other interested parties. The posting of such information on this website does not constitute any endorsement of the products described here nor validation of product claims. Individual health care organizations must determine whether these products are appropriate for use in their facilities.