Medical Product Evaluation Form


A medical product evaluation form is a document which is filled in by an evaluatee to assess the merits and demerits of a particular medical product. Such products cover a wide range like medicines, medical equipment bought by patients, ancillary equipment like blood pressure monitors, thermometers and so on. A medical product evaluation form must be filled in by consumers as they are the best persons to judge the efficacy of a particular medicine or medical equipment.

Sample Medical Product Evaluation Form:

Medical product evaluation form no #

Name of medical product: _____________________________

Date of medical product evaluation: ______________________ [dd/mm/yy]

Evaluator’s name: ______________________ Contact details: __________________

Please answer the following questions about the medical product you purchased:

1. For what purpose did you purchase the medical product? Did you find it easily accessible?

________________________________________________________________________

2. Did the medical product you purchase serve its purpose? Did you experience any side effects that you were not forewarned about?

___________________________________________________________________________

3. Did you require a prescription to access the medical product?

___________________________________________________________________________

4. How do you regard the price of the medical product when compared to its efficacy?

___________________________________________________________________________

5. Is this version of the medical product the first of its kind or is it an improvement of an extant version? If yes, mention the benefits or drawbacks of the newer version:

___________________________________________________________________________

Provide you comments and suggestions on the following factors of the medical product evaluation:

  • Affordability and accessibility: ______________________________
  • Quality and efficaciousness: _________________________________
  • Usage ease, safety and disposal issues: ____________________________________
  • Clarity of instruction manual [if present], presence of important details like expiry and manufacturing date on medical product: ______________________________________

 

 

 

User questionnaire

Category: Medical Evaluation

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