---
title: Medical Device Recall & Adverse Event Documentation Request Form Template | Paperform
description: Streamline requests for medical device recall documentation, FDA adverse event reports, manufacturer response letters, and device identification records with this professional template.
url: "https://paperform.co/templates/medical-device-recall-adverse-event-documentation-request-form"
type: static
generatedAt: "2026-03-31T00:49:03.491Z"
---

[← Back to free form templates](/templates/)    ![Medical Device Recall & Adverse Event Documentation Request Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/medical-device-recall-adverse-event-documentation-request-form.png)
    [Preview](https://_preview.paperform.co/ai-template/medical-device-recall-adverse-event-documentation-request-form) [Use this template for free](/create?ai-template=medical-device-recall-adverse-event-documentation-request-form)    [Request Forms](/templates/category/requests/)[Healthcare & Medical Forms](/templates/category/healthcare/)[Legal & Compliance Forms](/templates/category/legal/) [Healthcare](/templates/industry/healthcare/)[Legal](/templates/industry/legal/)[Medical Devices](/templates/industry/medical-devices/) [Physician](/templates/role/physician/)[Pharmacist](/templates/role/pharmacist/)[Healthcare Administrator](/templates/role/healthcare-admin/)[Lawyer](/templates/role/lawyer/)[Compliance Officer](/templates/role/compliance-officer/)[Risk Manager](/templates/role/risk-manager/)     About this free form template
When medical device recalls or adverse events occur, having rapid access to complete documentation is critical for patient safety, regulatory compliance, and legal protection. This Medical Device Recall & Adverse Event Documentation Request Form streamlines the process of gathering essential records from manufacturers, healthcare facilities, regulatory bodies, and internal quality teams.

Designed for healthcare administrators, quality assurance professionals, regulatory affairs teams, and legal departments, this template helps you collect all necessary information in one submission—from device identifiers and FDA report numbers to manufacturer response letters and incident timelines. Whether you're investigating a single adverse event, managing a class recall, or preparing for regulatory audits, this form ensures nothing falls through the cracks.

The form captures critical details including device identification (model, serial number, lot number, UDI), FDA report references (MDR numbers, recall numbers), event classification, affected parties, and specific document requests. Conditional logic routes requests based on whether you're dealing with a recall, adverse event, or both, ensuring requesters only see relevant fields.

Paperform's document upload capabilities allow supporting evidence to be submitted alongside the request, while automated email notifications ensure the right teams are alerted immediately. Integration with Stepper (stepper.io) can automate follow-up workflows—triggering reminders to manufacturers, routing urgent requests to legal counsel, updating tracking spreadsheets, and ensuring compliance deadlines are met.

For organizations managing multiple device types or facilities, this form provides the standardization and audit trail necessary for FDA inspections, litigation support, and quality management system compliance. By centralizing documentation requests in a professional, HIPAA-aware format, you reduce response times, improve accuracy, and demonstrate your commitment to patient safety and regulatory excellence.
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