T-012-044 SOUP Request and Approval Form
Request Information
| Field | Value |
|---|---|
| Request Date | YYYY-MM-DD |
| Requester Name | |
| Requester Role | |
| Project/Device |
SOUP Identification
| Field | Value |
|---|---|
| SOUP Name | |
| Version | |
| Vendor/Maintainer | |
| Repository/Website | |
| License Type | |
| Programming Language |
Intended Use
Purpose within the device
Instructions
Describe how this SOUP will be used within the medical device software. Include which software items/microservices will integrate this SOUP.
Justification for selection
Instructions
Explain why this SOUP was selected over alternatives. Consider factors such as functionality, community support, documentation quality, and maintenance status.
Alternatives considered
| Alternative | Reason for rejection |
|---|---|
Preliminary Risk Assessment
Patient data impact
- SOUP will process or have access to patient data
- SOUP will NOT process or have access to patient data
If yes, describe the data involved:
Safety criticality
- SOUP is involved in clinical decision support or diagnostic output
- SOUP is involved in safety-critical functionality
- SOUP is NOT involved in safety-critical functionality
If safety-critical, describe the impact:
Security considerations
- SOUP handles authentication, encryption, or security-sensitive operations
- SOUP has network/internet access capabilities
- Known vulnerabilities have been checked (CVE databases)
CVE check date: YYYY-MM-DD
Known vulnerabilities: ☐ None found ☐ Found (describe below)
Risk classification
Based on the assessment above:
- High-risk SOUP - Requires full validation per GP-019
- Medium-risk SOUP - Requires verification through software testing
- Low-risk SOUP - Standard integration with functional verification
License Compliance
| Question | Response |
|---|---|
| Is the license compatible with commercial medical device use? | ☐ Yes ☐ No |
| Are there any attribution requirements? | ☐ Yes ☐ No |
| Are there copyleft/viral license concerns? | ☐ Yes ☐ No |
License review notes:
Approval
Technical Review (JD-007)
| Field | Value |
|---|---|
| Reviewer | |
| Date | YYYY-MM-DD |
| Decision | ☐ Approved ☐ Rejected ☐ Requires modifications |
Technical comments:
Quality/Risk Review (JD-004)
| Field | Value |
|---|---|
| Reviewer | |
| Date | YYYY-MM-DD |
| Decision | ☐ Approved ☐ Rejected ☐ Requires modifications |
Quality/Risk comments:
Final Decision
- APPROVED - Proceed with SOUP integration and create T-012-019 SOUP documentation
- REJECTED - Do not integrate this SOUP (see rejection rationale below)
- CONDITIONAL - Approved with conditions (see conditions below)
Rationale/Conditions:
Record signature meaning
- Author: JD-007 Requester name
- Review: JD-007 Technical reviewer name + JD-004 Quality reviewer name
- Approval: JD-004 Approver name
Template signature meaning
Delete this
Delete this section when you create a new record from this template.
- Author: JD-004 María Diez
- Review: JD-007 Alfonso Medela
- Approval: JD-001 Andy Aguilar