Repair Evaluation
SAMPLE ONLY
Customer Account:
General Hospital
Property:
14003742
Model:
Philips C8-4v Big Adapter for iU22/HD9
Purchase Order #:
TBD
Serial:
02W9V8
Sales Order #:
20150324-22705
Date Received:
03-31-2015
Sales Representative:
D. Diggler
Date Evaluated:
04-01-2015
Technician:
Alice
Functional Tests
Pass Fail N/A Notes
Airscan
x
Multiple Shadows
Color
x
Intermittent Artifacts (Handle)
CW Doppler
x
FirstCall
Frequencies
x
Leakage
x
Phantom Image
Preset
x
PW Doppler
x
x
Multiple Consecutive Dead Elements, Multiple Non-Consecutive Dead Elements
x
Multiple Shadows
Ob/Gyn
Overall Condition:
D: Bad-
Cosmetic Tests
Pass Fail N/A Notes
Cable
x
Connector
Handle
x
Paint Chipped
x
Irregular, Nick(s)/Scratch(es)
x
Lens/Membrane
Orientation Mark
x
Strain Relief: Connector
x
Strain Relief: Head
x
Overall Condition:
D: Bad-
Repair Suggestion:
array damage
Repair Price:
$0.00
Estimate Lead Time:
Probable Cause of Damage:
wear and tear, rough handling dropped on probe head
#312434
Key Term Definitions:
Airscan: Image produced when transducer is first plugged in imaging nothing but air.
Array/Crystal: Critical part of transducer that produces and sends high frequency sound
FirstCall Capacitance: Objective diagnostic element test for broken wires or dead elements.
FirstCall Sensitivity: Objective diagnostic element amplitude test for array strength and
waves as well as receives resulting return pulses/echoes.
Array/Crystal Damage: One or more elements of the array are not working.
Color Noise: A spiking (interference) noise due to broken or frayed wires in color mode
Connector: Housing connector that plugs into system.
CW Doppler: CW (continuous wave) doppler allows measurement of blood velocities along an
entire line of interrogation.
CW Noise: A spiking (interference) noise for cardiac probes due to borken or frayed wires in
CW mode.
Dropout: Area or lines of no image typically corresponding with dead or weak internal
elements.
FirstCall: The industry standard for testing the acoustical and electrical properties of an
ultrasound probe.
penetration.
Lens/Membrane: Rubber section at the tip of the probe head which interfaces with skin.
Phantom: Device used to mimic tissue while scanning.
Phantom Image: Image produced when using phantom test device.
PW Doppler: PW (pulsed wave) doppler allows measurement of blood velocities at a single
point.
PW Noise: A spiking (interference) noise for cardiac probes due to broken or frayed wires in
PW mode.
Shadow: Same as dropout.
Strain Relief: Rubber section at either end of the ultrasound cable that allows cable/probe
head flexibility.
1137 E. Philadelphia St. Ontario, Calif. 91761 Tel 909.628.1778
Fax 909.628.1709 www.ultrasolutions.com
Images
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Pictures
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FirstCall
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Repair Approval Form
Client Signature:
Date Signed:
Please complete, sign, and return this authorization page
Model:
Philips C8-4v Big Adapter for iU22/HD9
Serial:
02W9V8
Property:
14003742
Sales Representative:
Dustin Riggs
Technician:
Alice Leyba
Date Evaluated:
04-01-2015
Date Received:
03-31-2015
Customer Account:
General Hospital
Purchase Order #:
TBD
Sales Order #:
201505
Repair Suggestion:
array damage
Repair Price:
$0.00
Estimate Lead Time:
Probable Cause of Damage:
wear and tear, rough handling dropped on probe head
Terms & Conditions
1. Quote is valid for 5 business days upon receipt.
2. Parts/Labor warranty is 60 days for standard probes and 30 days for 3D/4D and TEE probes. Warranty applies to work outlined above only, excluding
misuse and abuse.
3. Probe/Part is not guaranteed repairable until after final test is completed. The probe/part will be returned to customer at no repair charge if it is deemed
unrepairable.
4. The quote is subject to change once probe repair begins. For example, if it is found that there are non-OEM compenents in the probe/part this will cause
additional work to be performed. Customer will be notified in advance if quote is to change.
5. The nature of the repair requested/required for the above listed item introduces a significant risk of physical damage to the appearance and functional
performance of this item. The customer freely understands, accepts and fully assumes all risk and hazards associated with the repairs described above
including if item is further damaged during the process of the repair. Further, understanding these risks, the customer provides Ultra Solutions
authorization to attempt these repairs.
6. Ultra Solutions is not responsible for any items left at our facility over 90 days.
7. If customer chooses not to approve the repairs, there is a standard $150 labor fee for the estimate.
8. This is a good faith evaluation for repair of this probe. This evaluation may need to be revised upon disassembly.
9. Customer agrees to pay and will be liable for any and all collection costs, attorney fees and legal fees. In case of default and/or if accounts are not paid
within terms, a 1.5% per month or 18% annual penalty fee will be applied.
10. All parties agree to use electronic signatures and agree to be subject to the provisions of the U.S. ESIGN Act.
1137 E. Philadelphia St. Ontario, Calif. 91761 Tel 909.628.1778
Fax 909.628.1709 www.ultrasolutions.com