Purchase Request: Baguio General Hospital & Medical Center
Purchase Request: Baguio General Hospital & Medical Center
Purchase Request: Baguio General Hospital & Medical Center
Department of Health
BAGUIO GENERAL HOSPITAL & MEDICAL CENTER
Baguio City
Form No.: HS - PS - 001
PURCHASE REQUEST Revision No.: 2
Effectivity Date:December 1, 2015
D
Department Dept. of Surgery PR No.: January 8, 2022
Date:
Section: Neuro Surgery SAI No.:
Date:
ORS No./BURS No: .
Unit
Item of Stock Estimated
Qty. Item Description Estimated Cost
No. Issu No. unit Cost
e
Brainlab Kick System Php 1,550,000.00
Description
IGS SERVICES
1 1 1 SERVICE PACKAGE SOFTWARE - CRANIAL NAV
2 1 1 SERVICE PACKAGE KICK
1 1
VARIO REFERENCE ARM FOR MAYFIELD HEADHOLDER
1 1 STERILIZATION TRAY CRANIAL
1 1 SOFTOUCH REGISTRATION POINTER
1 1 ZTOUCH LASER POINTER
1 1 CRANIAL UNSTERILE ACCESSORIES CASE
1 1 STERILIZATION TRAY FOR VARIOGUIDE
1 1 VARIOGUIDE
1 1 REFERENCE HEADBAND STAR
IGS DISPOSABLES
1 10 REFERENCE HEADBAND (10 pcs)
1 5 DISP BIOPSY NEEDLE 1.8MM/150MM (5 PCS)
1 90 DISP REFLECTIVE MARKER SPHERE (90 PCS)
1 100 MULTI-MODALITY DONUT REGISTRATION MARKER (100 PCS)
Purpose: For OR USE
Required (For Procurement Management Office use only)
Attachments: Certificate of No
Stock Position Sheet for Acknowledgement Receipt suitable subtitute
Consumables for Equipment
Justification for none inclusion Biomedical Service Report / MIS Service Certificate of
in the PPMP Report Exclusive
Complete generic specification Distributorship
Scope of Work / Detailed Estimate Price
of item/s requested Quotation
Others:
Certificate of No suitable
subtitute
Certificate of Exclusive
Distributorship
Certificate of Exclusive
Distributorship
Price Quotation
Approved By: