Siemens SC 7000 - Clinical Site Report

Service Manual SC 7000 and SC 9000XL Patient Monitors
138 Siemens Medical Systems, EM-PCS, Danvers ASK-T898-03-7600
NOT A CONTROLLED DOCUMENT
7k9kXLSM.apd.CD_ROM.fm/04-99/kaupp
Clinical Site Report
Clinical Site Name: Date:
Address:
_______________________________________Clinical Site Facility Manager:
_______________________________________Clinical Site Contact Person:
Tel. No: FAX No.
Int’l Code Number Ext:
Monitoring Unit _______________________________
Care Unit
_________________
Monitor Style (check one): SC 7000 ____ SC 9000XL ____
Monitor Serial No. _________________________
Monitor has passed all required tests.
Siemens Service Representative:
_____________________________________________________________________ ________________
Name (Print) Signature Date
Clinical Site Representative:
_____________________________________________________________________ ________________
Name (Print) Signature Date