Republic of the Philippines

Department of Health
BAGUIO GENERAL HOSPITAL & MEDICAL CENTER
Baguio City
Form No.: HS - PS - 001
PURCHASE REQUEST Revision No.: 2
Effectivity Date:December 1, 2015
D
Department Dept. of Surgery PR No.: January 8, 2022
Date:
Section: Neuro Surgery SAI No.:
Date:
ORS No./BURS No: .
Unit
Item of Stock Estimated
Qty. Item Description Estimated Cost
No. Issu No. unit Cost
e
Brainlab Kick System Php 1,550,000.00
Description
IGS SERVICES
1 1 1 SERVICE PACKAGE SOFTWARE - CRANIAL NAV
2 1 1 SERVICE PACKAGE KICK

Wear Parts and Disposables

1 1 CRANIAL ACCESSORIES
1 1 POINTER WITH BLUNT TIP (W/ GAUGE)
2 2 REFERENCE CLAMP UNIVERSAL (W/ 2 ARRAYS)

1 1
VARIO REFERENCE ARM FOR MAYFIELD HEADHOLDER
1 1 STERILIZATION TRAY CRANIAL
1 1 SOFTOUCH REGISTRATION POINTER
1 1 ZTOUCH LASER POINTER
1 1 CRANIAL UNSTERILE ACCESSORIES CASE
1 1 STERILIZATION TRAY FOR VARIOGUIDE
1 1 VARIOGUIDE
1 1 REFERENCE HEADBAND STAR

IGS DISPOSABLES
1 10 REFERENCE HEADBAND (10 pcs)
1 5 DISP BIOPSY NEEDLE 1.8MM/150MM (5 PCS)
1 90 DISP REFLECTIVE MARKER SPHERE (90 PCS)
1 100 MULTI-MODALITY DONUT REGISTRATION MARKER (100 PCS)
Purpose: For OR USE
Required (For Procurement Management Office use only)
Attachments: Certificate of No
Stock Position Sheet for Acknowledgement Receipt suitable subtitute
Consumables for Equipment
Justification for none inclusion Biomedical Service Report / MIS Service Certificate of
in the PPMP Report Exclusive
Complete generic specification Distributorship
Scope of Work / Detailed Estimate Price
of item/s requested Quotation
Others:

Requested by: Approved By:

Signature:
Printed Name: FIDEL A. BALDOVINO JR., MD GARY U. ONG,MD,FPSP, FPSMS, MPH

Designation: CHAIR, DEPARTMENT OF SURGERY OIC- CMPS II

 Republic of the Philippines
Department of Health
BAGUIO GENERAL HOSPITAL & MEDICAL CENTER
Baguio City
Form No.: HS - PS - 001
PURCHASE REQUEST Revision No.: 2
Effectivity Date:December 1

Department: Dept. of Surgery PR No.:

Section: Neuro Surgery SAI No.:
ORS No./BURS
.
Item Unit of
Qty. Item Description Stock No. Estimated unit Cost
No. Issue

Terms and Conditions

A detailed inspection is performed once a year as part of the service
contract

Preventive Maintenance Inspections (PMI) have to be performed,

including

• Visual control of the cabling

• Camera checks
Camera sensors
Camera LEDs
Camera labels
• Power supply filter check
• CMOS battery lifetime check:
The CMOS battery must be exchanged after 3 years of lifetime of the
Kick system
• Functionality checks of the Monitor Cart and Camera Cart:
Arms, joints, and locks
Wheels and brakes
• Error log checks
• Operating system check, including:
Check of the currently installed operating system
Update of the operating system, if updates are available

The following PMI tasks must be performed only by trained,

BRAINLAB-authorized representatives:

• Check / exchange of the power supply filter

Check / exchange of the power supply filter
• Exchange of the CMOS battery
• Joint adjustment of the monitor arms
• Error log checks
• Operating system checks and updates

Purpose: For OR USE

Required Attachments: (For Procurement Management Office use only)
Certificate of No su
Stock Position Sheet for Consumables Acknowledgement Receipt subtitute
for Equipment
Justification for none inclusion in the PPMP Biomedical Service Report / Certificate of Exclus
MIS Service Report Distributorship
 Justification for none inclusion in the PPMP Biomedical Service Report / Certificate of Exclus
MIS Service Report Distributorship
Complete generic specification Scope of Work / Detailed Estimate Price Quotation
of item/s requested
Requested by: Approved By:
Signature:
Printed Name: FIDEL A. BALDOVINO JR., MD GARY U. ONG,MD,FPSP, FPS
Designation: CHAIR, DEPARTMENT OF SURGERY OIC- CMPS II
CAL CENTER

Form No.: HS - PS - 001

Revision No.: 2
Effectivity Date:December 1, 2015

Date: January 8, 2022

Date:
Date:

Estimated unit Cost Estimated Cost

Certificate of No suitable
subtitute
Certificate of Exclusive
Distributorship
 Certificate of Exclusive
Distributorship
Price Quotation
Approved By:

GARY U. ONG,MD,FPSP, FPSMS, MPH

OIC- CMPS II