Screen Reader Mode Icon

Question Title

* 1. Contact Information (Clinic)

Question Title

* 2. Affected Device

Question Title

* 3. Device CN

Question Title

* 4. Accident Date

Date

Question Title

* 5. Accident type

Question Title

* 6. Description of accident

Question Title

* 7. Documentation (photo / document)

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File
You can send additional photos to support@inventmedical.com

Question Title

* 8. Customer Request

Question Title

* 9. Did accident result in affecting patient's health?

Question Title

* 10. If patient's health was affected, please provide more information here.

Question Title

* 11. Was this accident reported by you to Healthcare Authority? 

0 of 31 answered
 

T