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LBL-2008-41-v5 OptoMonitor 3 IFU_en Rev 2021-08
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Appendix B- Installation Checklists
Representative:
(First name, Last name)
DATE
(YYYY-MM-DD)
:
Site information
Hospital name:
Cath lab # :
(if applicable)
OptoMonitor 3 Equipment
Item #
Equipment
Included
Serial Number / Lot Number
F2310
Optical Unit (OU)
□
F2320/F2321
Display Unit (DU)
□
F2330
Handle Unit (HU)
□
Instruments settings verified
Averaging Period Setting:
3
☐
Yes
☐
No
Graph Pressure:
0 to 150 or 0 to 200
Time scale:
6
I/O
Final OFFSET adjustment value
Final GAIN adjustment value
Aortic Transducer Input
Reference
N/A
Aux Input Reference
Distal Output Reference
Aortic Output Reference
N/A
Correct Pa Source Selected for Aortic Input Type?
☐
Yes
☐
No
Aortic Input Reference calibration performed according to IFU?
☐
Yes
☐
No
Distal Output Reference calibration performed according to IFU?
☐
Yes
☐
No
Aortic output Reference and calibration performed according to IFU?
☐
Yes
☐
No
Signature: