Radiancy SpaTouch Elite, Руководство пользователя

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41 SpaTouch Elite User Manual
Please specify device used:
Device Name: _____________________
Company: _________________________
Serial Number: _____________________
Where was the treatment done?
Name of Facility: __________________
Address: ________________________
________________________
________________________
Who performed the treatment?
Full Name: _______________________
Title: ________________________
Who is preparing and submitting this report?
Full Name: _______________________
Title: ________________________
What sort of treatment was performed ?_______________________
What was the treatment area: ___________________
First time the adverse effect was observed: (mm/dd/yy) _____ / _____ / ___
Date the adverse effect resolved: (mm/dd/yy) _______ / _______ / _______
Please describe in detail the event or problem. If there is not enough room,
continue on other paper and attach to report.
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
Treatment discontinued? Yes No
If yes, provide an explanation for discontinuation:
____________________________________________________________
____________________________________________________________