Old Bivona Trach Recall Verification Form

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Bivona Trach Recall Verification Form
To quickly identify impacted Bivona Recall patients, we have implemented a tool that allows you to verify whether your current stock of Bivona Tracheostomy Tubes is affected by the recent recall.
- To use this tool, locate the Lot Numbers on your UNOPENED product packaging (see images below).
- Then, click "Next" to visit our recall verification tool and enter the lot number(s) into the designated search field. Click the "Check Lot Number" button to see if your lot number is included in the recall.
- If your product is affected, follow the instructions provided for returning or disposing of the product safely. If you need assistance or have any questions, please contact our customer support team at: (877) 926-1452
You can find the lot number of the tracheostomy tube on the outside of the box or inside the box on the packaging, as pictured below:
Click "Next" to contiune

Patient Information
Patient Name:*

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityState

Zip Code
DOB:*

MonthDayYear
Date
Phone Number:*
Please enter a valid phone number.
Email:
example@example.com
If possible, please include your SuperCare Health account number, which can be found on any packing slips, work orders, or similar documents. Ok, too skip if you do not know it.
Patient Account Number:
Who is completing this form?*
Your Name:*

First NameLast Name

Recall Verification

Enter a valid lot number to check the recall status
1st Lot Number:
1st Recalled Lot Number:
!ALERT!

The lot number you entered is on the recall list.

Please DO NOT use this product
Recalled Trach Identified
Please hit "Next" to continue

Recall Verification

Enter a valid lot number to check the recall status
2nd Lot Number:
2nd Recalled Lot Number:
!ALERT!

The lot number you entered is on the recall list.

Please DO NOT use this product
Recalled Trach Identified
Please hit "Next" to continue

Bivona Trach Recall Verification Form