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Formulary and Best Practices Review Committee Forms Policy

Subject: Class III – Clinical – H. Patient Administration

Effective Date: 03/01/2023

Reviewed and/or Revised: 02/24/2024, 02/28/2024, 07/31/2025

Policy and/or Procedure:

This policy is to review clinic devices and materials. The request forms for the purchase of new and different items to replace current items are linked within this policy.

A faculty member would introduce the material, speak with the Program Director, and then their Department Chair would approve or disapprove. If approving, there must be justification for using this new material with an explanation as to why this material is superior to the materials currently being used. A cost analysis needs to be performed and noted on the form. The appropriate form is to be sent to the appropriate persons (see below) for approval. If approved, the Associate Dean of Clinical Affairs would notify the Director of CMS and/or School Store Manager. 

Faculty training of the product/device submitted for approval must be done to show how the product will be implemented. The new materials and new products should be discussed at the Department meetings. These meetings need to have minutes.    

If the product is a replacement, one of the requirements is to use the current item first. Faculty inform CMS/School Store who are responsible for checking inventory to assure the current item is used before ordering the new item. 

The necessary forms are as follows: 

  1. Formulary and Best Practices Review Committee Submission Form (DOC): This form is to show that we are using a new material for educational purposes. This form is to satisfy Standard 5.2. The instructions for completing the form are as follows:  
    1. This is the first form that has to be completed by the Faculty member, which is used to request using a new product or device. 
      1. There must be justification for using this new material with an explanation as to why this material is superior to the materials being used. 
      2. A Cost Analysis must be included.  
      3. The Form and back up documentation is reviewed/approved by the Faculty provider’s Department Chair. If approved, it is sent to the Associate Dean of Clinical Affairs for review/approval.  
      4. The Associate Dean of Clinical Affairs reviews to ensure it is clinically relevant and for any gift component or IT component. (NOTE: If replacing a current item, the inventory supply would be checked by the School Store Manager.) 
      5. If approved and the product has:
        1. No gift component or IT component then the form, cost analysis and back up information would go before the Formulary Committee for review and approval.  
      6. If approved, the form is stamped, approved, dated, and logged.
        1. If a gift component, then the form is sent to the Assistant Dean of Development to review/approve.
        2. If an IT component is present, the form is sent to the Executive Director of IT to review/approve.
        3. The form is then sent back to the Associate Dean of Clinical Affairs for Committee review/approval.

      Note: If the product/device is a non-gift item (for example: a new printer, demo machine, or software), the Executive Director of IT and Associate Dean of Clinical Affairs need to know the faculty/staff making the request, the name of the vendor, and the purpose of the product/device.  This applies to anything that has to be integrated into our IT system. This form is for products/devices we use in the clinics, (not on the research floors: 6th, 7th, 8th, and 9th floors). If the product/device has a specific purpose (printer, software, etc.), it is not a gift. If it is not a gift, it does not have to go through Assistant Dean of Development. 

  2. If the product is a clinical supply item, a Request for Clinic Supplies not Currently Available from the School Store Form (DOC) needs to be completed in addition to the Formulary and Best Practices Review Committee Submission Form and follow the process listed in item 1 above. 
  3. Formulary Form for Gifts Received: If  the item is a gift from a vendor, a Formulary and Best Practices Review Committee Submission Form (linked in item 1 above) needs to be completed and the process noted above must be followed. Then, all gifts need to go to the 6th floor. 

All gifts must:

  • First go to Assistant Dean of Development to be sure it is indeed a gift (with no conditions).
  • The requestor must log the meeting with the representative stating whom you met with and the company name. (Note: This is to ensure no conflict of interest. Even items such as a case of toothpaste need to be logged in with the Assistant Dean of Development.) 
  • Then, the request goes to the Executive Director for IT and HIPAA purposes. 
  • The last person who reviews the request is the Associate Dean of Clinical Affairs who ensures the request fits into the clinical program asking the following questions: 
    • Can we use it? 
    • What are the directions for use?
    • How is it sterilized or disinfected if for intra-oral use?
    • Has it been reported to CMS?