Medical device delivery note template
Medical device delivery note template for hospital supply: lot and serial numbers, expiry dates, sterile packs checked on arrival, and the receiving signature.
Templates by industry
- Infusion pumps, serial numbers listed
- Sterile infusion sets, boxes of 20
- Pressure monitoring kits
Preparation guide
Example workflow
Pick and pack
Example: count "Infusion pumps, serial numbers listed" and the other lines against the order, and note anything that ships later.
Ship with the note
Put the note in or on the shipment with the tracking number and package count, and check "Pressure monitoring kits" is listed.
Get it signed
Ask the recipient to sign and date the received-by line, and keep the signed copy as proof of delivery.
Hospitals trace medical devices from the dock to the patient, so a delivery note for them carries more than quantities. The receiving department checks each line’s lot or serial number and expiry date against the label, turns away sterile packs with damaged wrapping, and files the note so a recall can be traced to the ward. This template gives every line room for those identifiers and keeps serialised equipment apart from disposables counted by the box.
Fields to prepare
- Deliverables and line items
- Infusion pumps, serial numbers listed, Sterile infusion sets, boxes of 20, Pressure monitoring kits: record the quantity actually shipped for each line; prices stay off the note.
- Infusion pumps, serial numbers listed
- List each pump’s serial number; the biomedical engineering team books every unit into its asset register before it reaches a ward.
- Sterile infusion sets, boxes of 20
- Write the lot number and expiry date from the box label, and split the line if two lots arrived.
- Pressure monitoring kits
- Check that each kit’s sterile barrier is intact before the receiver signs; a torn pack is written as rejected, not counted.
- Order and delivery
- Quote the order or invoice number the delivery belongs to, the delivery date and the address the goods go to.
- Shipment
- Give the number of packages, the carrier or shipping method and the tracking number.
- Scope to agree
- Record the lot or serial number and the expiry date of every line as printed on the label, note that sterile packs arrived sealed, and keep the hospital’s order number on the note.
Before sending
- Was “Infusion pumps, serial numbers listed” counted when it was packed, and does the count match the order?
- If “Sterile infusion sets, boxes of 20” ships short, does the note say how many follow and when?
- Will the receiver be able to check “Pressure monitoring kits” against this note on arrival?
Show 3 more
- Check the delivery address, the number of packages and the order or invoice number the delivery belongs to.
- Count each line against the order, and list anything that ships later rather than leaving it off.
- Leave prices off the note unless the customer asks for them; they belong on the invoice.
Worked example with sample figures
The quantities below are invented to show how the template is filled in: 3 lines, counted in units, with no prices.
| Item | Quantity |
|---|---|
| Infusion pumps, serial numbers listed | 4 |
| Sterile infusion sets, boxes of 20 | 30 |
| Pressure monitoring kits | 12 |
| Total | 46 |
46 units in 3 lines.
- The goods ship against sales order SO-MD-3384.
- Packages: 7.
What the document must show
These details make a delivery note easier to approve and to file.
- Your company name and address
- The customer's name and delivery address
- Note number and delivery date
- The order or invoice it belongs to
- Each item with the quantity delivered
- Packages and carrier or tracking number
- A line for the recipient's signature and date
This document prints quantities without prices, so no tax appears on it unless you switch its line columns to prices and totals.
Frequently asked questions
Should loan equipment be on the same delivery note as purchased devices?
Better on its own note, marked as loan or trial, with the return date. Mixed on one note, a loaned pump can end up in the hospital’s asset register as if it were bought.
What if the hospital refuses stock with a short expiry?
Many hospitals set a minimum shelf life on arrival. Check the order for it, and if a lot falls short, call before delivering rather than letting the receiver reject it at the dock.
Does this delivery note show prices or tax?
This document prints quantities without prices, so no tax appears on it unless you switch its line columns to prices and totals. The worked example above counts 46 units and nothing else.
Can I use it in another language or currency?
Yes. The document language can be set to any of 33 languages, and changing the country setting updates the currency, the date format and the tax rate.
Can I change the layout and colour?
Yes. The editor offers other layouts and a document colour for the printed page. Changing them moves no figure: the lines and totals stay as they are, and the PDF, Word and Excel files follow the layout you pick.
Read next
Reading for the Medical device delivery note template: Quote, proforma, invoice, receipt, credit note: which to use and Unpaid invoice: follow-ups, part payments and statements. The order this delivery answers is written on the Purchase order template.