Supply Chain Follow Up

In order to ensure we can deliver products on time and that our production planning is in line with your planned operations. Please fill in this form on a monthly basis or when requested by GNM.

Name

First Name

Last Name

Hospital Name

Date

YYYY

Line

Number of Sentiva Model 1000 in stock

Number of Sentiva Duo Model 1000D in stock

Number of Aspire SR Model 106 in stock

Number of Electrodes Model 303 or 304 in stock

Number of Tunnelers model 402 in stock

Number of 502 Patient Kits / Magnets in stock

Line

Select Month for reporting activity

Number of Patients who changed batteries

Number of Patients who received their first VNS

Number of Patients who changed battery and electrode