Stellant D/Flex

Medrad Stellant D/Flex* This field is required.

BMET Name* This field is required.

First Name

Last Name

Email* This field is required.

your.name@trimedx.com

Date* This field is required.

Date

Work Order Number* This field is required.WOT

SID/CEID* This field is required.

Hospital Name* This field is required.

Department* This field is required.

Room* This field is required.

Display Serial Number* This field is required.

Head Serial Number* This field is required.

Head Mounting Type:* This field is required.

CRU Version* This field is required.

1. Clean/Inspect Display and Main Unit* This field is required.

2. Clean/Inspect Injector Head* This field is required.

3. Operational Checks* This field is required.General Operation Check Inputs Phase 1 Contrast A: 5.0 ml/s, 50 ml Phase 2 Saline B: 5.0 ml/s, 50 ml Phase 3 Contrast A: 10.0 ml/s, 100 ml Phase 4 Saline B: 10.0 ml/s, 100 ml

5. Volume and Flow Rate Checks* This field is required.Injection Duration Syringe A/B: 10 secs, +/- 1 sec. Injection Volume Syringe A/B: 50 ml, +/- 1 ml.

Seconds

Syringe A 10 secs, +/- 1 sec/50 ml, +/- 1 m

Syringe B 10 secs, +/- 1 sec/50 ml, +/- 1 m

Syringe A 10 secs, +/- 1 sec/50 ml, +/- 1 m

Syringe B 10 secs, +/- 1 sec/50 ml, +/- 1 m

Seconds

PSI Pressure Limit Verification* This field is required.A-Side Pressure Limit:8.0 ml/s, 80 ml and 300 PSI (+/-50) B-Side Pressure Limit: 8.0 ml/s, 80 ml and 300 PSI (+/-50)

PSI Readings

A-Side Pressure Limit: 300 PSI (+/-50)

B-Side Pressure Limit: 300 PSI (+/-50)

A-Side Pressure Limit: 300 PSI (+/-50)

B-Side Pressure Limit: 300 PSI (+/-50)

PSI Readings

Electrical Safety Test* This field is required.Outputs should read mOhms <150 Output should read mA <500

Out Put Readings

mOhms

Out Put Readings

Signature* This field is required.