Braile Biomédica

Implant Registration - Endovascular Prosthetics

Implant Registration - Endovascular Prosthetics

Patient´s name (initials):

Birth date:

Procedure date

Sex:

Doctor:

Hospital:

City:

State:

Country:

Medical agreement:

Distributor/Representative:

Vena Cava Filter:

Size (mm):

Embolization coil (cm x mm):

Size (cm x mm):

Peripheral Stent:

Diameter (mm):

Length (mm):

Surgical Stent-Graft

Diameter (mm):

Length (mm):

Serial number:

Note:

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