gobio.com/patients
For assistance, please call Customer Service at 1-877-593-6421
18
Good to Know
• Remove postage-paid shipping envelope from kit.
• Pack up the sensor, diary and any other unopened
supplies, and place into the envelope.
• Seal the envelope and mail back to us, via USPS.
There is no cost to you to mail back the equipment.
Returning the ePatch Sensor
For assistance, contact Customer Service:
1-877-593-6421 or www.gobio.com/patients
PLACE KIT
ID STICKER HERE
PATIENT DIARY
Patient Name:
Patient Address:
Physician Name:
Start Date:
Start Time:
Date Removed:
Extended Holter
Monitoring
SYMPTOM/EVENT DIARY
Date Time
am
/
pm
Check any feelings that apply:
Did you push the button/sensor to record a symptom
____ Yes ____ No
What were you doing when the symptom(s) occurred?
Activity:
____ Normal daily routine
____ Exercising
____ Sitting
____ Laying down/sleeping
____ Other
• Discard the used patch.
Patient
Name: ___________________________________________
Patient
Address: __________________________________________
__________________________________________
ENVELOPE CONTAINS A LITHIUM BATTERY
Doc No
. 220-04
19-0
1 R
ev
. A
Return Envelope