SonoSite MicroMaxx - Page 93

Appendix B: Service Event Report 87
Service Event Report
Instructions on reverse
Service Request
Order Number
For SonoSite Use Only
RMA Number
Service Provider
Name: Provider Reference:
Company: Date Reported:
Address:
Phone Number: Fax Number:
E-mail address:
Device Description
Name:
Ref Number:
Serial Number: Lot Number:
ARM/SHDB Version: Configuration:
Event Description
Diagnosis
Service Performed
Performed By: Date:
Parts Removed
Part Name Part Number Serial Number Lot Number Rev Replaced By
Parts Installed
Part Name Part Number Serial Number Lot Number Rev Replaced By
Tests Performed (attach test data)
Test: Test:
Performed By: Performed By:
Result: Pass Fail Result: Pass Fail
Attach additional sheets as required
Page ____ of ____ F00019 Rev D