University Hospital Kerry Cancel Equipment Order Form

Name of Person Cancelling Equipment*

Ward*
—Please choose an option—Rathass WardMuckross WardAghadoe WardCCU WardScellig WardClonfert WardICU WardReask WardArdagh WardPallative Care UnitA & E WardDenish WardLoher WardAnnagh WardValentia WardCashel WardKells WardMAUAcute Stroke UnitCARRIG WARD

Room Number and Patient Initials*

Return Email

Product*
—Please choose an option—Air MattressUpgrade Mattress

Product Rental Number* (e.g. OFM1234) located on the pump/foot of the bed

Comment

*indicates required field