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HCA Order Form
Division Far West Division
Site/Hospital Los Robles
Billing Delivery
Name Elizabeth.Cabada@hcahealthcare.com Name Kerri Steckel
Email George.Greene1@healthtrustpg.com Email Kerri.Steckel@hcahealthcare.com
Address Line 1 Clinical Education Financial Reporting Address Line 1 215 W Janss Rd
Address Line 2 Clinical Education Financial Reporting Address Line 2
Address Line 3 Suite 1100 Address Line 3
City Nashville City Thousand Oaks
State TN State CA
ZIP 37203 ZIP 91360
Items to Order
Code Description Quantity Total ($)
[980] Brayden Adult Compression Spring Addon 1 $23.84
[980] Brayden Baby/Infant Replacement Lung (single) 3 $29.76
[980] Brayden Baby/Infant Artificial Lung Air Guide 3 $4.98
[980] Brayden Baby/Infant Replacement Airway Tube (single) 2 $6.06
[980] Brayden Baby/Infant Spring 1 $15.99
  Sub-Total $80.63