FCI Complaint Form 112019 docx 2025

1. Click ‘Get Form’ to open the FCI Complaint Form 112019 in the editor.
2. Begin by filling out the 'Customer Information' section. Enter the facility name, surgeon's name, and complete address details including state, city, and zip code.
3. Provide contact information by entering the contact person's name, phone number, account number, and email address.
4. In the 'Date of Procedure' field, specify when the procedure took place. Then describe the incident in detail, noting when it occurred relative to surgery and any other devices used.
5. Indicate if there was a patient impact by selecting 'YES' or 'NO'. If applicable, explain how the patient was impacted and treated.
6. Fill in product details such as item number, description, lot/serial number, and expiration date. Attach a photo of the product if required.
7. Ensure you provide proof of decontamination for products that had patient contact before returning them.
8. Finally, sign and date the form to confirm that all information is complete and accurate.

Start using our platform today to fill out your FCI Complaint Form 112019 easily and for free!