Fresenius Medical Care GranuFlo Dissolution Unit II - Form: Granu Flo Batch Production

P/N 450368 Rev I 31
FORM: GRANUFLO BATCH PRODUCTION RECORD
Dialysis Unit Name & Location #:
GranuFlo Dissolution Unit II Serial #:
DRY ACID PRODUCT CASE INFORMATION
OPERATOR (print name):
DATE:
TIME:
Batch #:
CASE 1: Dry Acid Catalog # (label on box)
BOX Lot #
Potassium # (1K, 2K, 3K)
CASE 2: Dry Acid Catalog #
BOX Lot #
Potassium #
CASE 3: Dry Acid Catalog #
BOX Lot #
Potassium #
CASE 4: Dry Acid Catalog #
BOX Lot #
Potassium #
CASE 5: Dry Acid Catalog #
BOX Lot #
Potassium #
CASE 6: Dry Acid Catalog #
BOX Lot #
Potassium #
1. After Final Fill Level has been reached, CLOSE water supply valve to the Unit. Once this is done check the box. 
SPECIFIC GRAVITY
Measured Temp
Print Catalog # -Specific Gravity Value for the Measured Temp listed in Appendix A:
Measured Specific Gravity Value:
Check one
TEMP:
LOW:
HIGH:
-Pass
-Fail (void section)
OPERATOR SIGNATURE:
VERIFIER SIGNATURE:
DRY ACID PRODUCT CASE INFORMATION
OPERATOR (print name):
DATE:
TIME:
Batch #:
CASE 1: Dry Acid Catalog # (label on box)
BOX Lot #
Potassium # (1k, 2k, 3k)
CASE 2: Dry Acid Catalog #
BOX Lot #
Potassium #
CASE 3: Dry Acid Catalog #
BOX Lot #
Potassium #
CASE 4: Dry Acid Catalog #
BOX Lot #
Potassium #
CASE 5: Dry Acid Catalog #
BOX Lot #
Potassium #
CASE 6: Dry Acid Catalog #
BOX Lot #
Potassium #
1. After Final Fill Level has been reached, CLOSE water supply valve to the Unit. Once this is done check the box. 
SPECIFIC GRAVITY
Measured Temp
Print Catalog # -Specific Gravity Value for the Measured Temp listed in Appendix A:
Measured Specific Gravity Value:
Check one
TEMP:
LOW:
HIGH:
-Pass
-Fail (void section)
OPERATOR SIGNATURE:
VERIFIER SIGNATURE:
DRY ACID PRODUCT CASE INFORMATION
OPERATOR (print name):
DATE:
TIME:
Batch #:
CASE 1: Dry Acid Catalog # (label on box)
BOX Lot #
Potassium # (1k, 2k, 3k)
CASE 2: Dry Acid Catalog #
BOX Lot #
Potassium #
CASE 3: Dry Acid Catalog #
BOX Lot #
Potassium #
CASE 4: Dry Acid Catalog #
BOX Lot #
Potassium #
CASE 5: Dry Acid Catalog #
BOX Lot #
Potassium #
CASE 6: Dry Acid Catalog #
BOX Lot #
Potassium #
1. After Final Fill Level has been reached, CLOSE water supply valve to the Unit. Once this is done check the box. 
SPECIFIC GRAVITY
Measured Temp
Print Catalog # -Specific Gravity Value for the Measured Temp listed in Appendix A:
Measured Specific Gravity Value:
Check one
TEMP:
LOW:
HIGH:
-Pass
-Fail (void section)
OPERATOR SIGNATURE:
VERIFIER SIGNATURE: