Recall Reply Form - Multi-parameter Command Module

Please complete and submit the form below to acknowledge the following:

You have received and understand the referenced Medical Device Notification.
Your organization has informed appropriate staff, has taken and will take appropriate action in accordance with this this Notification.

Reference:

740-0015-00, Cardiac Output Functionality in Multi-parameter Command Module (Model 91496)

Confirmation *
By checking this box, I acknowledge the receipt and understanding of the associated medical device notice, confirm that I will carry out the actions outlined, and that I am authorized to acknowledge this notice on behalf of the organization listed below.By checking this box, I acknowledge the receipt and understanding of the associated medical device notice, confirm that we at the site listed below do not have any of the affected products outlined in the referenced medical device notice, and that I am authorized to acknowledge this notice on behalf of the organization listed below.

Preferred Remediation option:

Update firmware at repair depotReplace AFE board on siteExchange module

Organization Name*

Department/Unit*

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Contact Name*

Contact Job Title or Function*

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