implant card

Instruction for completion

  1. Name of the patient or patient ID. To be filled by healthcare institution/provider.
  2. Date of Implantation. To be filled by healthcare institution/provider.
  3. Name and Address of the healthcare institution/provider. To be filled by healthcare institution/provider.
  4. Manufacturer’s information website.
  5. Device type in the required language.
  6. Device Name.
  7. LOT Number.
  8. Expiration Date.
  9. Name and Address of the manufacturer of the implanted medical device.

 

Explanation/Translation of symbols

Patient Name or Patient ID

Name and Address of the implanting healthcare institution

Date of Implantation

Device Name

Manufacturer

Information Website for Patients

LOT Number

Expiration Date