Quest Engineering MPS 3 - Page 28

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Perfusion Training Checklist
Contingencies
I hereby acknowledge that I have trained the operator on the above MPS 3 elements.
I hereby acknowledge that I have attended training on the above
Phase Two MPS 3 elements and understand the information outlined.
One Allentown Parkway
Allen, Texas 75002-4211
☐ Blood Bypass Tubing Back-up
☐ MPS 3 Console Change Out Procedure
☐ MPS 3 Controller Change Out Procedure
☐ MPS 3 Disposable Change Out Procedure
☐ Case History, Case Reports, Error Report
Trainers Name
Date
Name of Perfusionist
Signature of Perfusionist
Email Address
Site Name
City / State
Date
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