INTERNATIONAL SERVICE CENTER
Contents
1. ER REGISTRATION FORM Section II DOCUMENTATION RECORD Facility A Please list all Service Center personnel who have been trained in the servicing of Mediaid Inc Pulse Oximeters according to current Mediaid Inc procedures and policies provided in the Service Guides and User Manuals listed in Part B Technician s Name please print Date Signature Trained Use additional pages if necessary and indicate here the number of attachments B Current documentation on file at this facility Service Guide for the 300 Series Pulse Oximeter Service Guide for the Model 400 Pulse Oximeter Model 300 Series User sManual i Oo O Model 340 Vet User s Manual Model 400 User s Manual Pulse Oximeter Parts Price List All Models Other specify I the undersigned affirm that the information I have provided in Sections II and III of this Registration Form is true Name Title please print Signature Date PT001 030409 Rev 1 Mediaid Inc 17517 Fabrica Way Suite H Cerritos CA 90703 USA Telephone 714 367 2848 FAX 714 367 2852 SERVICE CENTER REGISTRATION FORM Section III Facility WARRANTY AGREEMENT The Mediaid Inc Limited Warranty for Mediaid Inc Pulse Oximeters will be extended to this Service Center provided that 1 The Service Center maintains the physical and procedural working environment specified in the Service Guides and additional documentation provided by Medi2. Mediaid Inc 17517 Fabrica Way Suite H Cerritos CA 90703 USA Telephone 714 367 2848 FAX 714 367 2852 SERVICE CENTER REGISTRATION FORM Section I Date Facility Telephone Mailing Address FAX E Mail Contact Personnel for Please print names amp phone numbers Communications Technical Support Please answer the following questions 1 Is your facility currently acting as a service center for servicing and repairing electronic equipment 2 How long has your service center been established 3 How many technicians are on staff 4 Please indicate the name and location city and state of the hospital school or institute where your technicians received their training and the type of training they received Example Torrance Memorial Hospital Torrance CA USA trained on Electrocardiographs 5 What type of medical equipment do you service Please list types 6 Do you have the following equipment that may be used in servicing Mediaid Inc Pulse Oximeters Anti static Work Station Multimeter Yes O No and equipment U No Variable voltage DC power 44 pin PLCC chip extractor tool U Yes U No supply with Amp meter U No Regular amp Phillips screwdrivers Yes U No PT001 030409 Rev 1 Mediaid Inc 17517 Fabrica Way Suite H Cerritos CA 90703 USA Telephone 714 367 2848 FAX 714 367 2852 SERVICE CENT
3. aid Inc 2 Servicing is limited to and performed according to the Service Guides and additional documentation 3 Documentation and records specified by Mediaid Inc will be completed for all service work I the undersigned agree to the above conditions and affirm that our service technicians have received and read the documentation and instructions that are listed in the document Mediaid Inc Service Center Policies J understand that these conditions must be met before our Service Center may complete any authorized servicing of Mediaid Inc Pulse Oximeters Name Title please print Signature FOR MEDIAID INC USE ONLY Date Registration Rec d Documentation Complete L Yes LI No Service Center Approved L Yes LI No Approved by Name please print Signature Date PT001 030409 Rev 1
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