HeartWare HVAD - Page 3

All problems should be promptly reported to your clinician. Before you leave the hospital,
add names and contact information below. It is very important to keep this information
available in case something happens to you or to your HeartWare
™
HVAD
™
System.
Name
Ofce
Pager
Mobile
Name
Ofce
Pager
Mobile
Name
Address
Implant Surgeon Name
Phone Number
Company Phone Number
CLINICIAN CONTACT
IMPLANTING HOSPITAL
AMBULANCE
Contact Information