Your Full Name: Your Email Address: Facility Name: Zip Code to ship to: Pre-Operation: Additional Notes: Stretchers - Per Patient Load Estimate – Oxygen Flowmeters – Ohio Quick Connect/Disconnect Recommended(Due to ease of locating parts and/or spare units) Suction Regulators - Choice of Continuous / Continuous -Variable Suction Canisters – Various Sizes Available – Recommend 1500cc Headwalls - Consisting of both suction , O2 Flow and Suction Canister Slide Receptacle for Each Patient Monitor(s) – Either Separate or Multi-parameter. Advise ECG, SAO2, NIBP. Optional: Recorder (Recommended only if Hard Copy Required), CO2, Temperature Mobile Blood Pressure Unit as Back-Up (Inexpensive) Temperature Units – Either w/ probe or Tympanic (At least one is Recommended, even if Temperature is Included on Patient Monitor.) Supply Cart – Usually Stainless Steel, i.e., Lakeside Cart or Similar Overbed Table – Recommended Oto/Ophthalmoscope - Recommended, portable Examination Stools – Various Styles. Options: Pneumatic, Screw, or Fixed Height Operation. Recommend New Stools for Value/Life Expectancy. Surgical Scrub Sink – single, double or triple bay. Infrared or knee operation Optional: Patient Scale – Optional: Height Rod Surgery: Additional Notes: Surgery Table – Per Surgeon – Optional: Manual or Electric Operation, C-Arm Compatible, Armboards, Stirrups, Knee Crutches, Cystoscopy Tray/Catcher, etc. Anesthesia Machine – Configured per Surgeon/Anesthesiologist. Recommend North American Drager or GE-Datex. Options include volume or volume/pressure ventilation. Peep and Scavenge included. Anesthesia Cart – Various Styles. Locking Drawers/Compartments a Necessity. Anesthesia Gas Monitor / Patient Monitor– Various Models Available – To Surgeon/Anesthesiologists Comfort Level for Ease of Use/Necessary Configuration. All to incl;ude ECG, SpO2, NIBP, Printer. Gas Monitor to be capable of all Five Agent Gases and EtCO2 with External Water Trap. Options Include: Agent ID, FiO2. Various Manufacturers. Oxygen Flowmeter – Ohio Quick Connect/Disconnect Recommended (Due to ease of locating parts and/or spare units). One Recommended per Surgery Suite. Suction Regulators - Choice of Continuous / Continuous-Intermittent. Two Recommended per Surgery Suite. Headwalls – Consisting of Suction, O2 Flow and Suction Canister Slide Receptacle. Ohio Quick Connect/Disconnect Receptacles Recommended. Two Such Headwalls Recommended, one utilized by Anesthesia Unit, the other utilized during procedures. Optional: Single Headwall Receptacle for only Suction in Addition to the Two Recommended Previously. Suction Stands – Includes ability to hold up to four Suction Canisters of Varying Sizes. Only Recommended if procedures will be performed in which high volumes of fluid are expected. Mayo/Instrument Stand – Various Sizes and Styles Available X-Ray View Boxes – Models Range from Single Box to Bank of 6, Auto Power On, Recessed or Wall Hanging, Various Bulb Quantities for Different Levels or Illumination. Back/Instrument Table – Mobile - Various Sizes Available from 3’ to 6’ long and Widths from 24” to 36”. Optional: Lower Shelf. Supply Cart: Lakeside or Similar Electro Surgical Unit – Varying Styles and Manufacturers. Dependent on type of Procedures Performed. Varying Power Outputs. Recommended: BiPolar/MonoPolar Operation w/ Foot Pedal Actuation, Cart Surgery Lights – Varying Outputs (Lux) and Configurations. Configurations: Single or Dual Head, LED Recommended, Center Mount 360 Degree Swivel or Track Mounted, Fixed Brightness or Wall Mounted Intensity Control (Usually Installed Pre-Construction) . Sterilizable Handle. Various Manufacturers. Surgeons Stool – Various Styles and Configurations Anesthesiologist Stool – Various Styles and Configurations Kick Buckets w/ Carriage IV/Syringe Pump (please indicate whether or not you will be using Propofol or any other anesthetic which requires special consideration for pump selection) Optional for Surgery: Additional Notes: Supply Cabinet – Fixed Upright Cabinet, Usually with Glass Door(s) and Stainless Steel Construction. Range in Height from 5’ - 6’, and 24” – 40” Wide. Space available determining Factor. Optional: Locking Doors, Pull Out Writing Surface, Lower Drawers/Cabinets Surgeons Headlamp and Light Source – Various Styles and Manufacturers Also Available: Endoscopy, Aspirators/Suction, C-Arms, Tourniquets, Surgical Microscopes, Various Pumps, etc. Procedure Suite: Additional Notes: Power Procedure Chair – Various models and features to fit the needs of the procedures being performed. Midmark procedure chairs most popular. Procedure Light – Either ceiling mounted or on mobile stand. Single head and dual head configurations for ceiling mounted types. Mayo Stand – Economy usually ok. Syringe Pump – For Conscious Sedation, if necessary Anesthesia Cart Patient Monitor – Multi-parameter with ECG, SpO2, NIBP, Recorder. Add Co2 if using sedation. Other possible required equipment: Electro-surgery unit, Bipolar Coagulator, Small Back/Instrument Table, etc Post Operation: Additional Notes: Stretchers - Per Patient Load Estimate – Various Styles Oxygen Flowmeters – 0-15L/Min, Various Connections to Wall (Please Advise) Suction Regulators - Choice of Continuous / Continuous-Variable, Various Connections to Wall (Please Advise) Suction Canisters – Various Sizes Available – Recommend 1500cc Headwalls – Consisting of Suction, O2, and Suction Canister Slide Receptacle for Each Patient. Patient Monitor(s) – Included parameters ECG, SpO2, NIBP, Temp, Recorder. Color Screen. Optional: CO2 Vital Signs Monitor(s) – Usually considered for step-down recover. Recommend at minimum NIBP, SpO2, Pulse Rate. Optional Recorder and Temp. Temperature Units – Either w/ probe or Tympanic (At least one is Recommended, even if Temperature is Included on Patient Monitor.) Supply Cart – Usually Stainless Steel, i.e., Lakeside Cart or Similar Overbed Table(s) – Recommended Oto/Ophthalmoscope - Recommended Examination Stools – Various Styles. Options: Pneumatic, Screw, or Fixed Height Operation. Recommend New Stools for Value/Life Expectancy. Privacy Screens – Various Styles/Types. Custom made to necessary dims. Privacy Curtains – Track Mounted – One for Each Patient Area Blanket Warmer - Various Styles and Sizes per Caseload. EKG Unit – 12 Lead. Options: Preview Screen, Full Page or Strip Record, Rhythm Strip, Interpretive/Non-Interpretive, Ability to Enter Patient Data, Measurements, Battery Backup (Recommended) and Cart Patient Warming System: Recommended Bair Hugger or Similar Wheelchair(s) Sterile Supply: Additional Notes: Sterilizer/Autoclave – Type Dependent on Work Load. Various Sizes from 7” Diameter to 36” and Up. Various Options Include: Automatic Door Opener for Drying Cycle, Printer. Larger Units Require Water Supply with Ample Water Pressure, Floor Drain, and Steam Generator. Washer / Utensil – Type dependent on Work Load. Pass through option from soiled to clean available. Various Sizes. Sterilization Trays – Dependent on Type of Instruments to be Sterilized. Ultrasonic Cleaner: Various Styles and Sizes Dependent on Work Load. Options: Heat Scope Washer - If Endoscopy Will be Performed. Wrapping Table – To Tech’s Preferences Other Critical/Equipment: Additional Notes: Crash Cart – Various Styles Half Backboard – Standard and Included on Crash Cart IV Pole – Standard and Included on Crash Cart O2 Tank Holder – Standard and Included on Crash Cart Defibrillator: Various Manufacturers and Options. Recommended: Biphasic, Sync, Recorder and ECG Monitor. Optional: Pacing, Advisory (AED) Suction: Portable Suction to Be Placed on Crash Cart. Standard Unit, Small, Portable Double Locking Narcotics Box - Wall Mount or Recessed. Various Sizes Available Suture Stand – Various Sizes - Dependent on Surgeons Preference Sharps Containers IV Poles – Dependent on Staff’s Requirements IV Pumps - Various Styles – Battery Backup – Optional: Single or Dual Channel. Various Manufacturers. Fluid Warmer – Used for IV Therapy or Similar – Maintains Fluid at Comfortable Temperature for Patient Supply Equipment: Additional Notes: Mobile Racks for Supplies – Various Sizes and Styles Glove Box Holders Large Suture Cart - For Central Supply Various Small Circulation/Supply Carts – i.e. Lakeside Instruments: Additional Notes: Must Consult, Various Endoscopy: Additional Notes: Must Tailor to Need, Consult