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21
IN
-SER
VICE
GUIDE
EVENCARE G3 BLOOD GLUCOSE
MONITORING SYSTEM:
CERTIFIED INSTRUCTOR RECORD
The following individuals have undergone the appropriate training on the EVENCARE G3 Blood Glucose Monitoring
System and are certified to serve as instructors in blood glucose monitoring using the EVENCARE G3 Blood Glucose
Monitoring System. They are qualified to perform initial training of certified operations, conduct performance
reviews, and maintain records concerting Certified Operators.
Medline Representative Signature
Medline Representative Printed Signature
Date
DATE
NAME
TITLE
RE-CERTIFICATION DATE