Newport e360 - Circuit Test & Diagnostic; Software Upgrade Form

SER360 A1106 2-19
SECTION 2
NEWPORT e360 VENTILATOR SOFTWARE UPGRADE FORM
COMPLETE FORM MUST BE FAXED TO NEWPORT REGULATORY AFFAIRS UPON
COMPLETION OF UPGRADE.
Fax completed form to: 1.714.427.0839 attention RA/QA
Or email requested information to: regulatory@NewportNMI.com
Facility Name: __________________________________________________________________
Facility Address: ________________________________________________________________
______________________________________________________________________________
e360 Model: WWE
❑ WWP ❑ WWS ❑ USS ❑ Other ❑ ______
______
Language: ____________________________________________________
Current Hours: __________________________________________________
e360 Model Serial Number: ________________________________________
Old software version: ____________________________________________
Updated software version:
________________________________________
Company performing service: ______________________________________
Address of company performing service:______________________________
Software Updated
by: ____________________________________ Date: ______________
Exhalation Flow Sensor Calibration,
d9 performed
by:
____________________________________
Date:
______________