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HCA Order Form
Division Capital Division
Site/Hospital HCA Healthcare Center for Clinical Advancement
Billing Delivery
Name Luke.Routzon@hcahealthcare.com Name Luke Routzon
Email George.Greene1@healthtrustpg.com Email luke.routzon@hcahealthcare.com
Address Line 1 Clinical Education Financial Reporting Address Line 1 7300 Beaufont Springs Dr.
Address Line 2 Clinical Education Financial Reporting Address Line 2 Suite 300
Address Line 3 Suite 1100 Address Line 3 .
City Nashville City Richmond
State TN State VA
ZIP 37203 ZIP 23225
Items to Order
Code Description Quantity Total ($)
A99003 Brayden Power Adaptor for Adult & Baby, 110v, 8ft cord, U.S. Plug 4 $58.60
S17013 Brayden Baby/Infant Replacement Airway Tube (single) 5 $15.15
S17011 Brayden Baby/Infant Artificial Lung Air Guide 5 $8.30
C17001 Brayden Baby/Infant Replacement Lung (single) 3 $29.76
  Sub-Total $111.81