Clone of Stellant D/Flex

Medrad Mark 7 * 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 Injection Volume: 50 ml Injection Flow Rate: 10.0 ml/s Injection Pressure: 600 Rise Time: 0.0

5. Volume and Flow Rate Checks* This field is required.Injection Volume: 50 ml Injection Flow Rate: 5.0 ml/s Injection Pressure: 600 Rise Time: 0.0

Seconds

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

Seconds

PSI Pressure Limit Verification* This field is required. Pressure Limit: 680 PSI (+/- 145) Flow Rate: 12.0 ml/sec Volume Rate: 120 ml Rise Time: 0.2

PSI Readings

Pressure Limit: 680 PSI (+/- 145)

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.