EQUIPMENT REPAIR ORDER
EQUIPMENT REPAIR ORDER Please fill out this form email to [email protected] & include a hardcopy with your shipment. Send equipment to: BIO-MEDICAL EQUIPMENT SERVICE 2709 SOUTH PARK ROAD LOUISVILLE, KY 40219 USA Your Purchase Order Number: Contact Person: Email: Phone: Ext: Ship Facility Name: To: Shipping Address: Shipping Address: City: State: Zip code: Country: Facility Name: Bill Billing Address: To: Billing Address: City: State: Zip code: Country: Reason for Shipment: Repair Equipment Manufacturer: Description of Issue: Error Code(s): Safety Check CNSystems Calibration Model #: Serial #: For questions contact Partners in Medicine at (314) 324-2470 Packing List for Task Force Monitor The following parts are required: Part Packed Task Force Monitor Main device (large blue Lucite box) Firewire cable (connects TFM and computer) Power cord ECG cable ICG cable ! ! ! ! ! Continuous BP Module (small blue Lucite box) Flying-V cuff (large) Flying-V cuff (medium) Flying-V cuff (small) Air hose (clear) ! ! ! ! ! Oscillometric BP Upper arm cuff (medium) Upper arm cuff (large) Air hose extension (black) ! ! ! There is no need to include the computer or monitor with your shipment. Packing List for CNAP Monitor The following parts are required: Part Packed CNAP Monitor Main device Power cord and adaptor ! ! Finger Cuff CNAP Controller (mounts on forearm) CNAP Controller cable Finger cuffs (all sizes) ! ! ! Oscillometric BP Upper arm cuffs (all sizes) Air hose extension (black) ! !
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