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INDICATIONS FOR USE — The POCA06-5L Oxygen Concentrator is intended for use as an oxygen
concentrator to provide supplemental low flow oxygen therapy in the home, nursing homes , patient care
facilities, etc.
Under certain circumstances, oxygen therapy can be hazardous.
Seeking medical advice before using an oxygen concentrator is advisable.
Physician Information
Physician Name:
Telephone:
Address:
Prescription Information
Name:
Oxygen liters per minute
at rest:
other:
Oxygen use per day
Hours:
Comments:
POCA06-5L oxygen Concentrator Serial Number:
(check one)
□5-Liter
HINOR Provider Information
Service Person:
This instruction guide was reviewed with me and I have been instructed on the safe use and care of the
POCA06-5L Oxygen Concentrator.
Signature:
WARNING
during activity：
Minutes:
□
Date:
Page 3 of 16
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