-B--

NELLCOR
PURITAN
BENNETT.
:ustomer Name:
D DMr'IUhl I TY t"!ED leAL
450 GREENFIELD AVENUE
ATTN


Customer Number Customer P.O. Number

Product Number SerlaVlot Number
GO:385
i
:j.90:;'
SHIPPING ADDRESS:
Service Report Date
Nellcor Puritan Bennett LLC
2800 Airwest Blvd.
Plainfield, IN 46168
Toll-Free Telephone
1-800-875-8062
6/29/1:0
FAX (317) 8376206
Page
SERVICE REPORT
Request Number
B3;}113-'OOl
Service Performed
Ship Instructions
LAE UGA
, , ;;" V"J to
your Nellcor Puritan Bennett equipment
Please see below for the results of our
Factory Servjce evaluation
reoDr-ted ";lJIT'r+;c\ffi '}Ief;
40 N40 NO READINGS (OXIMETRY)
Condition
Dperation
Reason
II)
(nmponent
\,IEP I F I ED REPORT:ET' SVMPTOr-!
130P\nn
BAD;; LH\lNEC -I ION
ASSY,MONITOR,STEEL TOOL P
SP.RfE,L.CD PCB WILeD NPB-
\( 0 U r e q u j p men t; , inc 1u din 9 So [) f' t melr e J has
been updated to current levels
where appllcable
The following additional opel'stIons were
nr:"ffo1"med
i'lpeT'Btion

l'lssembl\}
Component
nEPL.ACED CDI'1PDNErrr

r-\:3SY, i'-1ONITClR, STEEL TUOL P
/)SbY,. E:NGLOEiURE, TOP:, NPB-40
1
'our eqUipment, including software, has been updated to current revision levels where applicable. The equipment has been sUbjected to and passes all applicable testing i
lspeclions prior to return shipment.
;peclal Instructions
MPORTANT:
you receIved a 10Mer while your equipment was beingserviced, pleasereturnthe instrumentto NellcorPuritanBennett(NPB)to theshlpplng addresslisted.You may lise
1esameNPBcartonInwhichyour equipment Is retumed. Be sureto placethe NPB'ReturnedGoodsAuthorltatlon' (RGA)numberon theoulllide 01the carton. This number
, referenced in the 'Comments' sectionot the repair shipping document.
orlurther, assistance you may contact NellcorPuritanBennettTechnical Servlcas at 1-8008758062.
'he Service Warranty on the reverse side Is Nellcor Puritan Bennett's sole warranty with respect to the service performed under this reJ.ort.
BILLING ADORES!
Covldlen
675 McDonnell Blvd.
Sl. Louis, MO63042
Telephone 1.800.635.526;
Fax 1.886.222.9799
4-024185
--.
NELLCOR
PURITAN
BENNETT.
:ustomer Name:
HANFORD COMMUNITY MEDICAL
GFFJ::f\WI ELDA'/ENUE
"yrTN I;;;ECEIVING
HANFORD CA
ATTN: APOLLO LADUCA
Customer Number Customer P.O. Number
1()C) C) f:J '7;:?
Product Number SeriaULol Number
SHIPPING ADDRESS:
Nellcor Puritan Bennett LLC
2800 Airwest Blvd.
Plainfield, IN 46168
Toll-Free Telephone
1-800-875-8062
FAX (317) 837-6206
Service Report Date

Page
SERVICE REPORT
Request Number
13 551.13-00 :1,
Service Performed
:n

Assembly
Component
Operation:
F\ edS (J 11
AS'5e1l10 1q
,"'umpunent:
Ship Instructions
APOLLD Lp,EUGA
DAMAGE
ASSYMONITOR, STEEL TOOL P
FAR BATTERY COVER,NPB-40
REPLACED
pr:.(EVENTf'},T I \iE fvlA I f\ TENA!\IC'[
ASSY, MONITOR, STEEL 'fOOl P
F'AEL ''':jl/JITCH PANEL,I'JPB-ij.C
.ff you have
!3erv:lce Report,
j tan Benn;0tt
questions regarding this
please contact Nellcor
Technical Services.
2
our equipment, including software. has been updated to current revision levels where applicable. The equipment has been subjected 10 and passes all applicable testing c
spections prior to return shipment.
peela. Instl\lctlons

yourecalveda loanerwhileyour equipment wasbeingserviced. please ratumthe instrument to Neltcor Puritan Bennett (NPB) to theshlpplr1g address listed. YoumayUIl&
e sameNPBcartonin whichyourequipment Isreturned. Besureto placethe NPB"Returned Good$Au1horlzat!qn' (RGA) number on the 0l/l$1de of the carton. Thisnumber
referenced in the "Comments' sactlon of the repairshipping document.
Ir furtherassl$Ull1ce youmaycontact Nellcor Puritan Bennett Teoonlcal Services atl-8oo-1175-8062.
1eService Warranty on the reverse side Is Nellcor Puritan Bennett's sole warranty with respect to the service performed under Ihls report.
BILLING ADDRESS
Covidlan
675McDonnell Blvd.
$1. Louis. MO63042
Telaphona1.600.635.5267
Fax 1.888.222.9799
4-024185-1