DeVilbiss PulseDose PD1000 - Important Information

Important Information
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PHYSICIAN INFORMATION
Name: __________________________________________________________
Address: ________________________________________________________
_______________________________________________________________
Telephone: ______________________________________________________
Emergency Telephone: _____________________________________________
PRESCRIPTION INFORMATION
Patient’s Name: __________________________________________________
Flow Setting (LPM):_______________________________________________
SET-UP INFORMATION
Name of Person Setting Up: ________________________________________
OXYGEN PROVIDER
Emergency Telephone Number: ______________________________________
This instruction guide was reviewed with me and I have been instructed on
the safe use and care of the DeVilbiss PulseDose oxygen conserving device.
_______________________________________________________________
Patient or Caregiver Signature Date