Siemens SC 7000 Service Manual page 154

Service Manual
Clinical Site Name:
Address:
_______________________________________Clinical Site Facility Manager:
_______________________________________Clinical Site Contact Person:
Tel. No:
Int'l Code Number
Monitoring Unit _______________________________
_________________
Care Unit
Monitor Style (check one): SC 7000 ____ SC 9000XL ____
Monitor Serial No. _________________________
Monitor has passed all required tests.
Siemens Service Representative:
_____________________________________________________________________ ________________
Name (Print)
Clinical Site Representative:
_____________________________________________________________________ ________________
Name (Print)
138
Clinical Site Report
FAX No.
Ext:
Signature
Signature
Siemens Medical Systems, EM-PCS, Danvers
NOT A CONTROLLED DOCUMENT
SC 7000 and SC 9000XL Patient Monitors
Date:
Date
Date
7k9kXLSM.apd.CD_ROM.fm/04-99/kaupp
ASK-T898-03-7600