Attachment_21_-__Acknowledgement_of_Final_User_Inputs_Template.docx

Acknowledgement of Final User Inputs for Navy Temecula Outpatient Clinic Initial Outfitting Addition/Alteration Equipment Package

Department: __________________________

I have reviewed the final equipment layout and equipment selections for my department and have no further changes other than those documented during my meeting with the IO Contractor Name Medical Equipment Planner. I understand that any further changes must be formally submitted to Name of Agency via a User Change Request through the Commander, Clinic Name. I acknowledge that I will have an opportunity to review the final equipment package and layout for accuracy, but no further changes will be considered without submitting my request in writing through the proper approval channels described above.

Department Representative Signature: __________________________________

Printed Name/Rank: ____________________________________________

Date: _______________________________