Radiology OneSource

Mammography Form:

Printable Version
I would like to purchase a system with the following specifications or...
I would like to sell a system with the following specifications.

Manufacturer	Model		Production Year
S/N	SiteID		Available Date
SW Rev	Current Settings	50Hz 60Hz

Tube Type:

Exposure Count:

Housing:

Focal Spots:

Compression

Manual

Automatic

Magnification

SID

Fixed

Variable

Range:

Phototiming:

Number of Paddles

Compression:

Spot:

Magnification:

Biopsy:

Other:

Number of Apertures:

Accessory Cart Included

Bucky

18x24

24x30

	Auto ID
	Label Printer

Glass Shield

Cracks?

Stereotactic upright device model:

Prone Table Model:

Tube Type:

Exposure Count:

Housing

Focal Spots:

All System software and service codes must be on site and provided at time of removal.

All system manuals (operator and technical) must be on site and provided at the time of removal.

All service records must be on site and provided at the time of removal.

All phantoms must be on site and provided at the time of removal.

This installation is:	fixed	mobile
System is:	owned by facility	financed (owned by finance company/bank)

System Details

System is in good working condition and not in need of repair?

System is under service contract.

with:

Location in facility (room number)

on floor

Loading dock is available?

System being replaced by:

Notes:

Site Info

Company/Entity:
* Name/Rep: *
* Email: *
Phone:
Deal Status:
Address:
Address (cont.)
City:
State/Province:
Country:
Zip Code: