Get Bivona Custom Trach Order Form 2020-2025
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How to fill out the Bivona Custom Trach Order Form online
The Bivona Custom Trach Order Form is essential for individuals requiring a customized tracheostomy tube. This guide provides clear, step-by-step instructions to assist you in completing the form online.
Follow the steps to fill out the form accurately.
- Click ‘Get Form’ button to access the form and open it in the editor.
- Indicate the shaft length by entering the measurements for 'Shaft Length' and 'Extra Horizontal Length' in millimeters. Ensure that the 'Shaft Length' is between 30mm and 140mm, and the 'Extra Horizontal Length' does not exceed 30mm.
- Select the inner diameter (I.D.) and outer diameter (O.D.) that suit the requirements. Mark the appropriate boxes corresponding to your choices.
- Choose a connector type by selecting between 'Swivel,' 'Fixed,' or 'No ISO Connector.' Please note the restrictions regarding compatibility.
- Determine the neck flange option: indicate whether the neck flange has a swivel connector or is a fixed connector version. Specify the neck flange length required from the available options.
- Select the cuff specifications, choosing from options like 'TTS Tight to Shaft' or 'Aire-Cuf Pedi,' depending on your needs.
- Select any additional shaft options available, including 'Std. Curved,' 'Hyperflex Reinforced-Straight,' or types of cuffs and attachments, making sure to note relevant measurements wherever indicated.
- Complete the approval section, ensuring all fields are filled out clearly, including the hospital or clinic name, date, clinician's signature and credentials, and patient or client ID.
- Choose the type of service you wish to request. Options include a standard service or express service, selecting any additional qualifications as necessary.
Complete your Bivona Custom Trach Order Form online to ensure your specific tracheostomy tube needs are met effectively.
Portex tracheostomy tubes are manufactured by Smiths Medical, known for their range of advanced medical devices. They prioritize patient safety and comfort in their designs. For a diverse selection of tracheostomy products, explore the Bivona Custom Trach Order Form.
Fill Bivona Custom Trach Order Form
Template Order Forms. Fixed Flange Silicone Tracheostomy Tubes. 8. Approval Please note: ICU Medical will review the completed template for compliance. 5.0 mm I.D. Adult shaf or above only. Features include Fixed Flange, FlexTend, and Adjustable Flange options. Sign In To Purchase. - Customized: use a template to modify one of our standard Bivona® tubes. Bivona® Inner Cannulae. Bivona Custom Trach Tube NS, 6.0, EA ; Item. SU19LN60NGZ133N ; Customer Service.
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