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HCA Order Form
Division Continental Division
Site/Hospital HCA Healthcare Center for Clinical Advancement
Billing Delivery
Name Scott.Bartholomew@HealthONEcares.com Name Scott Bartholomew
Email George.Greene1@healthtrustpg.com Email Scott.Bartholomew@HealthONEcares.com
Address Line 1 Clinical Education Financial Reporting Address Line 1 333 W. Hampden Ave
Address Line 2 Clinical Education Financial Reporting Address Line 2 Suite 200
Address Line 3 Suite 1100 Address Line 3 .
City Nashville City Englewood
State CO State CO
ZIP 37203 ZIP 80110
Items to Order
Code Description Quantity Total ($)
A17001 Brayden Baby/Infant Cotton Diaper 1 $15.75
S17013 Brayden Baby/Infant Replacement Airway Tube (single) 10 $28.90
C17001 Brayden Baby/Infant Replacement Lung (single) 10 $94.50
S17011 Brayden Baby/Infant Artificial Lung Air Guide 10 $15.80
  Sub-Total $154.95