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1. Reviewer: (Required.)

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2. Application # and Country (Required.)

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3. Clinical Need (Required.)

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4. Clinical Need rating comments

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5. Hospital Infrastructure (Required.)

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6. Hospital Infrastructure rating comments

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7. Surgical Equipment (Required.)

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8. Surgical Equipment rating comments

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9. Admin & Political Support (Required.)

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10. Admin & Political rating comments

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11. Training and Sustainability (Required.)

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12. Training and Sustainability rating comments

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13. Self-Sufficiency (Required.)

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14. Self-Sufficiency rating comments

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