BioTel Heart ePatch, Руководство по обучению пациентов, Страница: 4 / 28

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4
Kit Contents
PATIENTS RIGHTS and
RESPONSIBILITIES
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ECG Pr
ep Kit
(2)
Epatch
(1)
Pr
ep Scr
ub
(1)
Raz
or
(1)
Enr
ollment
F
or
m
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1
3
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Sensor
Patch Pouch
Skin Prep Kit
Patient Education Guide
Return Envelope
Diary
1 3
4
2
6
5
For assistance, contact Customer Service:
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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
Patient
Name: ___________________________________________
Patient
Address: __________________________________________
__________________________________________
ENVELOPE CONTAINS A LITHIUM BATTERY
Doc No
. 220-04
19-0
1 R
ev
. A
Return Envelope
Before you Begin