iRhythm ZIO XT PATCH - Patient Instructions and Log Usage; Prescribed Wear Duration; Symptom Logging Procedure; Patch Return Process

PATIENT INSTRUCTIONS
& BUTTON PRESS LOG
FOR SUPPORT, CALL 1.888.693.2401
NAME:
PHYSICIAN:
START DATE: / / TIME:
REMOVAL:
/ /
DATE REMOVED:
Physician prescribed duration of days
Patient to wear as long as possible (up to 14 days)
iRhythm Technologies, Inc.
Clinical Centers
650 Townsend St., Suite 380
San Francisco, CA 94103
2 Marriott Drive
Lincolnshire, IL 60069
1.888.693.2401 | irhythmtech.com |
@iRhythmTech
TO BE COMPLETED BY PATIENT
USING THE




Based on individual wear experiences your actual
wear time may be shorter than prescribed.
Open for Patient Instructions and FAQs.

Press the ‘ZIO’ button.
Write the symptom in the Button Press Log.

On cover, write in “Date Removed.”
See last page for how to remove the ZIO® XT Patch.

How long am I supposed to wear the ZIO® XT Patch?
Wear the ZIO® XT Patch according to your physician
prescribed wear time but no longer than 14 days.
NOTE: Based on individual wear experiences your
actual wear time may be shorter than prescribed.

Yes, but keep showers short and keep soaps and
lotions away from the ZIO® XT Patch.

Yes, but keep the ZIO® XT Patch above water. The
ZIO® XT Patch should not be submerged in water.

ZIO® XT Patch is on?
No.
What if I don’t have symptoms?
That’s okay. The ZIO® XT Patch is designed to
capture every beat.

Yes, but activities that cause excessive sweating can
cause the ZIO® XT Patch to slide, become
loose, fall o, and shorten wear time.

If it is working properly, the ZIO® XT Patch will not
flash or make noise.
What if the ZIO® XT Patch falls o?
Call Customer Support. We are available 24 hours a
day, 7 days a week.
How do I return the ZIO® XT Patch?
Place it (along with the Patient Instructions & Button
Press Log) in the original postage-paid box and drop
it o at the Post Oce, in a USPS (blue) mailbox or
give it to your mail carrier.
Button PREss Log
...while I was
...because I felt:
anxious
arm or neck
pain/tingling
chest pain
or pressure
dizziness
fainted
light headed
pounding
fluttering or racing
short of breath
skipped beat(s),
irregular beats
other (describe):
I pressed the button on...
describe
activity
minorless
minsorless
...for this duration:
hourorless
Morethanhour
:
h m m
AM
PM
hm d ym d y
12

Do not use the ZIO® XT Patch on patients with known
allergic reactions to adhesives or hydrogels or have a
family history of adhesive skin allergies.
Do not use the ZIO® XT Patch in combination with external
cardiac defibrillators or high frequency surgical equipment.
Do not use the ZIO® XT Patch near strong magnetic fields
or devices such as MRI.
Do not use the ZIO® XT Patch on patients with a neuro-
stimulator, as it may disrupt the quality of ECG data.
Do not use the ZIO® XT Patch on patients who do not have
the competency to wear the device for the prescribed
monitoring period.
CAUTION: Federal (USA) law restricts the sale of this
device to or on the order of a physician.
N100A4710.04 | Mar. 2014
FOR SUPPORT, CALL 1.888.693.2401
iRhythm Technologies, Inc. | irhythmtech.com | @iRhythmTech