On-Site ePump and Joey Decommissioning Form

Cardinal Health Canada On-Site ePump and Joey Decommissioning Form

Pumps older than 2021 can be disposed of on-site if this form is completed for affected pumps. Pumps that are decommissioned in this way cannot be used as a source for parts or used to treat patients with feeding sets. Future repairs will not be performed on pumps with the serial numbers indicated below, and repairs for these pumps cannot be completed on-site after decommissioning. We assume no liability for continued use of pumps decommissioned through this process.

Contact Details

Account Number

6 or 7 digit customer number

Sales Representative Name (Optional)

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First Name

Last Name

Phone (optional)

Fax Number (optional)

Job Title/Role

Address (City, Province & Postal Code)

Hospital, Institution or Company Name

Please provide a Microsoft Excel, Word, or Adobe PDF Document with the full listing of serial numbers that you will decommission on-site.

By completing this form and clicking the following button, you acknowledge that you have decommissioned the pumps identified below and have disposed of them according to local hospital and/or provincial protocols and guidelines, and confirm that the pump will not be resold. Batteries may need to be disposed of separately from the pumps. After acknowledging below, you will be taken to another page to provide your signature.

I acknowledge that I will decommission the pumps identified above.

Contact Information