Atrotech Atrostim PNS Anwenderhandbuch Seite 52

Atrostim PNS
IMPLANTED NERVE STIMULATOR
Registration Form B
IMPLANTATION DATE
Instructions:
Use these symbols:
RIGHT SIDE
TICK ELECTRODE POSITION
CRANIAL
CRANIAL
DIST AL
DISTAL
CRANIAL CRANIAL
DISTAL DISTAL
April 2008
PATIENT
Complete the sites of implant stimulators, connectors and
electrode matrices on both sides (drawing below).
Keep original copy for physician/patient records.
Fax the filled-in form to Atrotech.
1 = IMPLANT STIMULATOR
2 = CONNECTORS
= ELECTRODE
21
Surgical procedure for pediatric patients
ATROTECH Co.
P.O.Box 28
FIN-33721 TAMPERE
FINLAND
Phone +358 3 383 1300
Fax
(Pay attention to the location of the cut corner!)
LEFT SIDE
TICK ELECTRODE POSITION
1
CRANI AL
DISTAL
2
CRANIAL
3
DISTAL
4
5
6
7
8
9
10
11
APPENDIX 3
+358 3 383 1324
CRANIAL
DISTAL
CRANIAL
DISTAL