Ultra Sound Data Sheet

Please note: All fields marked with * are mandatory

Name: *
Phone:*
Email:*
Hospital:*
Department:*

 

Manufacturer
Model name
Model number
Year of installation

Blackwhite doppler yes Colour doppler yes
no no

 
Probes   Type Model number

Camera Yes      Camera type
No

Is the machine in
good working order?          
List any known problems

Date available for removal
Location of equipment
Optional equipment: (optical disk etc)

                                                                    

 

 

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