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Gamma Camera Form
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
110-130 Vac
220-240 Vac
Head Count
Single, Dual, Triple?
Orbiter
Yes
No
Extended Reach
Digitrac
List Collimators Included:
Collimators Carts
Exchanger
Automatic
Semi-Automatic
Manual
System
Spect
Planar
Cardiac
Whole Body
General Purpose
Vascular
Thickness of Crystals
Detector
Square
Round
Size
x
Original Crystal Replaced
Yes
No
if yes, when?
Controls Integrated
Yes
No
Analog
Digital
Computer Information:
Computer Included
Yes
No
Comp Platform Type
Integrated
Yes
No
DOM
SW Type
SW Level
Monitor
Color
B/W
Quantity
type:
Printer
Yes
No
If yes,
type:
Imager/Multiformatter
Yes
No
If yes,
type:
R Wave Trigger
Yes
No
If yes,
type:
Second Workstation
Yes
No
If yes,
type:
Other Equipment:
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
No
Yes
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:
