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HCA Order Form
Division Capital Division
Site/Hospital Stonesprings
Billing Delivery
Name Luke.Routzon@hcahealthcare.com Name Michelle Muztafago
Email George.Greene1@healthtrustpg.com Email michelle.Muztafago@hcahealthcare.com
Address Line 1 Clinical Education Financial Reporting Address Line 1 2440 Stone Springs Blvd
Address Line 2 Clinical Education Financial Reporting Address Line 2
Address Line 3 Suite 1100 Address Line 3
City Nashville City Dulles
State TN State VA
ZIP 37203 ZIP 20166
Items to Order
Code Description Quantity Total ($)
[980] Brayden Baby/Infant Artificial Lung Air Guide 10 $16.60
[980] Brayden Baby/Infant Replacement Lung (single) 5 $49.60
[980] Brayden Power Adaptor for Adult & Baby, 110v, 8ft cord, U.S. Plug 2 $30.76
  Sub-Total $96.96