Innosonian, Inc
Innosonian, Europe
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| HCA Order Form |
| Division | North Florida Division | ||
| Site/Hospital | Lake Nona Hospital | ||
| Billing | Delivery | ||
| Name | dan.fran@hcahealthcare.com | Name | Dan Fran – HCA CCA (Sim Center) |
| George.Greene1@healthtrustpg.com | dan.fran@hcahealthcare.com | ||
| Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | 6400 Sanger Rd. Suite 2155 |
| Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | |
| Address Line 3 | Suite 1100 | Address Line 3 | |
| City | Nashville | City | Orlando |
| State | TN | State | Florida |
| ZIP | 37203 | ZIP | 32827 |
| Items to Order | |||
| Code | Description | Quantity | Total ($) |
| C99003 | Brayden Adult Airway Filter (Pack of 24) | 3 | $13.38 |
| C99002 | Brayden Adult Airway Silicone Flap Valve (Pack of 24) | 3 | $23.25 |
| S13107 | Brayden Adult Airway Valve Assembly | 6 | $22.50 |
| C99101 | Brayden Adult Face Skin Piece | 6 | $92.28 |
| S13106 | Brayden Adult Face/Mouth Connector | 6 | $15.90 |
| S17011 | Brayden Baby/Infant Artificial Lung Air Guide | 15 | $24.90 |
| C17006 | Brayden Baby/Infant Double Filter (Pack of 5) | 3 | $89.31 |
| S17013 | Brayden Baby/Infant Replacement Airway Tube (single) | 15 | $45.45 |
| C17001 | Brayden Baby/Infant Replacement Lung (single) | 15 | $148.80 |
| A99003 | Brayden Power Adaptor for Adult & Baby, 110v, 8ft cord, U.S. Plug | 6 | $92.28 |
| C99008 | Brayden Premium Urethane Adult Lung Kit (Pack of 6) | 1 | $92.61 |
| S16402 | Brayden Pro Adult Body Skin Magnet | 12 | $49.68 |
| $0.00 | |||
| Sub-Total | $710.34 | ||