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Yearly AED Quality Check (Send Offs)
Date Verification Performed
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+
Instrument Sent For Yearly Preventative Maintenance?
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Yes
No
If Not, Please Explain?
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Documentation Received From Maintenance Check
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AED Serial Number:
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Sumner AED 400006719 Due 2020
Dental AED 301005124 Due 2019
Westside AED 400015533 Due 2019
Signature of Nurse Completing Form
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