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Activate Spare Equipment

    This form is to be used when activating spare equipment.


    Name of person logging this transfer*


    Patient MRN No.*


    Asset No.
    OFM

    ( The asset number for equipment can be found located on the O’Flynn Medical label as ‘Rental Number: OFMXXXX’.
    This can be most likely found on the pump. )


    Location*


    Date of Transfer*: Year Month Day


    CAPTCHA Code:captcha
    Enter Code*: (Type Text shown on the image above)

    *indicates required field