If you have product that is 120 Days out, document the expiration date in this form below. In the Quanitity, Item # Date sections of the spreadsheet. Then start the submission process for replacement through the Medical Supply Order Form, make a notation in the notes field (“Expiring Medical Equipment Replacement”). See below the date calculator available to assist you on determining the number of days out. Please select the checked boxs below to show that the item/items have been reviewed, even if you have nothing reaching the 120 days out. This form will not submit unless you select the check boxes. Submission of one form per apparatus.