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Customized Procedure Pack Configuration
Rev.
11/
16
Please indicate pack details as specified below: Quotation for approx. _______ packs p.a. ____ sterile samples ___ non sterile samples
Customer:
Street:
Postcode / City / Country:
Contact Person:
Pack Description:
______________________________________________
______________________________________________
_ _ ____________________________________________
______________________________________________
Tel: ______________ Email:_______________________
______________________________________________
Patient Drape System:
______cm x ______cm Dimensions Material waterproof fluid-repellent
system none 1 piece 2 pcs integrated separated perforated none
yes none
Fluid Collection Pouch Incision Foil Adhesive Rim Bridge yes none
Armboard Cover:
Dimensions / Quantity ____cm x ____cm ___pcs Tape yes none
Drape Table Cover (folded inside the pack): Dimensions / Quantity ____cm x ____cm / ___pcs Dimensions / Quantity ____cm x ____cm / ___pcs
Fenestration
Surgical Gown:
SMMS Size___: __pcs Size___: __pcs Size___: __pcs Softesse Size___: __pcs Size___: __pcs Size___: __pcs
Surgical Gloves:
Latex Size___: __pair Size___: __pair Size___: __pair Latex-free
Towel: yes:___pcs none
desired Dimension: ______________
Knives / Scalpels: Description / Size pcs
________
________
________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________ ________
Wrap / Packaging:
Drape Crepe Dimensions: ____cm x ____cm
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biocon Medizintechnik GmbH | Triebweg 1 - 3 | 63933 Mönchberg | Germany | Tel.: +49 9374 9730-0 | Fax: +49 9374 7311 | [email protected] | www.biocon-online.de
Size___: __pair Size___: __pair Size___: __pair
BB_biocon_Seite2_HKS_RZ.indd 1 16.06.15 08:02
Rev.
11/
16
Standard Cannulas / Special Cannulas:
Description / Size pcs
________ _____________________________________________
_____________________________________________ ________
_____________________________________________ ________
_____________________________________________ ________
_____________________________________________ ________
Instrument Wipe
none
You are welcome to contact Mrs. Blank-Hodai for questions and for individual consultation. Tel: +49 9374 9730-40 | [email protected]
Medicine Cup: Disposal Cup: 125 ml: ___pcs 60 ml: ___pcs
Bowl: 1-part: ___cm x ___cm 2-part: ___cm x ___cm 3-part: ___cm x ___cm
1 ml ___pcs 2 ml ___pcs 5 ml ___pcs Syringes:
Luer Connection Luer-Lock Connection 1 ml ___pcs 2 ml ___pcs 5 ml ___pcs
10 ml ___pcs 20 ml ___pcs
Gauze Compress:Gauze Sponge:
Plumsize: ___pcs 5 x 5 cm 8-ply:___pcs Eggsize: ___pcs 8-ply:___pcs Fistsize: ___pcs
7,5 x 7,5 cm 10 x 10 cm 8-ply:___pcs
12-ply:___pcs 16-ply:___pcs 12-ply:___pcs 16-ply:___pcs 12-ply:___pcs 16-ply:___pcs
Eye Shield:
____pcsEye Pad:
small, open: ___pcs small, closed: ___pcs large, open: ___pcs large, closed: ___pcs
Ocular Sticks: ____pcs
___pcs ___pcs
___pcs
Cotton Swabs: small, wooden: small, plastic: large, wooden: large, plastic: ___pcs
Other:
_________________________________________________________________________________________
_________________________________________________________________________________________
Our quality management system has been certified. Our medical device products carry the CE mark and meet all legal requirements. The entire production processes are being controlled and documented, and
are subject to permanent control.
Certified according to EN ISO 13485 Standard and Appendix V of the MDD 93/42/EEC
Page 2 of 2
biocon Medizintechnik GmbH | Triebweg 1 - 3 | 63933 Mönchberg | Germany | Tel.: +49 9374 9730-0 | Fax: +49 9374 7311 | [email protected] | www.biocon-online.de
60 ml: ___pcs
3 ml ___pcs 10 ml ___pcs 20 ml ___pcs
yes ___pcs
