Electromed SmartVest - Prescription Record

SmartVest SQL Airway Clearance System
www.smartvest.com
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Prescription Record
Prescription Record
SmartVest SQL Airway Clearance System
Serial # _____________________________
Prescribed Protocols
User One ____________ User Two ____________ User Three ____________
Date ________________ Date ________________ Date _________________
______times/day ______times/day ______times/day
______minutes/treatment ______minutes/treatment ______minutes/treatment
______pressure setting ______pressure setting ______pressure setting
Frequency Duration Frequency Duration Frequency Duration
_________ _________ _________ _________ _________ _________
_________ _________ _________ _________ _________ _________
_________ _________ _________ _________ _________ _________
_________ _________ _________ _________ _________ _________
_________ _________ _________ _________ _________ _________
_________ _________ _________ _________ _________ _________
Aerosols ____________ Aerosols ____________ Aerosols ____________
NOTE: Do not change your protocol without first consulting your health care
provider.