CHAD Evolution OM-900 - Notes

27
IMPORTANT INFORMATION TO RECORD
Your Name: __________________________________________________________________
Date You Received Your Unit: ____________________________________________________
Prescribed Oxygen Flow Setting:
• At Rest: ____________________________
• During Exercise: _____________________
Home Care Provider’s Name: _____________________________________________________
Home Care Provider’s Phone Number: (_______) _____________________________________
Physician’s Name: ______________________________________________________________
Physician’s Phone Number: (_______) ______________________________________________
Notes: __________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________