Ultra-Slim Duodenoscope Access Program

��ߺ��Corporation of the Americas (OCA) is committed to supporting the highest-quality patient care. The Ultra-slim Duodenoscope Access Program provides qualified organizations with a specialty duodenoscope used in small anatomy procedures for conditions such as biliary obstruction and cholestasis.

Through this charitable program, eligible organizations can seek an annual qualification from our Grants Committee. Scopes can be provided for a single-patient use charitable rental, subject to eligibility, inventory availability and the terms of the charitable program agreement.

Eligibility Requirements:

U.S. healthcare facility
501(c)(3) or similar tax-exempt status
Good standing with the ��ߺ��Medical Grants Program (if applicable)
Compliance with program rules regarding product use and rental returns

Qualification Process

Step 1: Submit Qualification Materials

Complete and submit the Qualification Form and prepare the required documents.

Submit required documents to grants-americas@olympus.com:

Organization’s Form , signed and dated within the last two years
Organization’s IRS Determination Letter confirming tax-exempt status

Step 2: Internal Review

��ߺ��Grants Committee completes annual internal review

Step 3: Contracting

If approved, organization must execute Olympus’ master agreement outlining program terms and conditions. Organization will receive instructions for how to request the PJF-160 scope via the ��ߺ��product rental process.

Seeking qualification during our annual process is strongly recommended.

Organizations not prequalified at the time of their product request may experience a delay as ��ߺ��completes the required internal review.

��ߺ��reserves the right to change or terminate this charitable program at any time, with or without notice. This decision may be made for any reason, and it is not subject to prior communication or notification. Prequalified organizations should be aware that its eligibility to participate in this charitable program and the charitable program as a whole is not guaranteed indefinitely.

Frequently Asked Questions

How long can I keep the PJF-160 scope?

The Ultra-slim Duodenoscope Access program is intended to provide the PJF-160 scope for a single-patient use. The scope cannot be kept by the organization and must be returned to ��ߺ��immediately after its use.

When should I order the PJF-160 scope?

Inventory of this device is limited; therefore, a PJF-160 scope should only be requested when it is needed for a procedure. Please do not order a scope if you do not have an upcoming procedure.

Please contact your ��ߺ��sales representative to check for product availability when scheduling your applicable procedure. All requests as subject to eligibility, inventory availability, and the terms of the charitable program agreement.

Is this program available outside of the United States?

The Ultra-slim Duodenoscope Access program is available only in the United States.

Does completing the qualification process guarantee the supply of a PJF-160 duodenoscope?

Prequalification does not guarantee that ��ߺ��has agreed to supply PJF-160 duodenoscopes to a prequalified organization, but merely entitles the prequalified organization to make a rental request, subject to eligibility inventory availability and the terms of the charitable program agreement.

How are qualification determinations handled by Olympus?

All qualification determinations are made by ��ߺ��Corporation of the Americas (OCA) Grants Committee, in its sole discretion. Qualification determinations are communicated via email to the names provided under the Contact Information Section of the Qualification Form. All decisions are final.

To begin your request for Ultra-slim Duodenoscope Access Program qualification, please complete the form below.

Indicates required field

Organization Details

Organization's Legal Name

Address

City

State

Postal Code

Organization Tax Identification Number/Employer Identification Number (TIN/EIN)

��ߺ��Account Number - this is the “Sold To” number on your invoices

Web URL

Description of Organization/Mission Statement

Contact Information

First Name

Last Name

Title

Phone

Are you authorized by the organization to sign a legal contract from ��ߺ��(if an award is made)?

Yes

Authorized Signer First Name

Authorized Signer Last Name

Authorized Signer Title

Authorized Signer Business Role

Authorized Phone Number

Authorized Signer Email

Projected Use

How many procedures per year do you anticipate requiring a PJF-160?

Do you have an immediate/urgent case requiring a PJF-160 scope?

Yes

Date scope is needed

By checking this box, I certify that this request was completed by the undersigned on behalf of the requesting organization. I certify the accuracy of the information provided in this request and the hereto attached documents. I certify that there has been no condition of purchase, use, or recommendation of ��ߺ��products associated with the request by the requesting organization or any parties related thereto.

By checking this box I indicate I have read, understood, and agree to Olympus’ Privacy Policy.

Please note: Submission of this Form is the first of two required steps. After clicking Submit below, please email the following required documents to grants-americas@olympus.com:

Organization’s Form , signed and dated within the last two years
Organization’s IRS Determination Letter confirming tax-exempt status

Recommended email subject line “Ultra-Slim Duodenoscope Access Program”.

Questions?

Please contact the ��ߺ��Grants Team - Americas
Email: grants-americas@olympus.com
Tel: 484-896-3939