Formulaire De Rapportage Des Defaults - F Care Systems Rafaelo Manuel D'utilisation

MANUEL THERMOCOAGULATION –RAFAELO

8 Formulaire de rapportage des defaults

This card must be returned to F care systems within 15 days after occurrence of a
problem with the
RAFAELO
F care systems NV
Oosterveldlaan 99
B-2610 –WILRIJK-ANTWERP - Belgium
Fax: +32 3 451 51 39
Email:
Info@F Care systems.com
I, undersigned (name and function)............................................................ state that, when
using EVRF N° : ;;;;;;;;;;;.. , on date ;;;;;;. to have experienced the
following problem with the RAFAELO:
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NAME and SIGNATURE STAMP
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Telephone number:
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Email:
Date 6/04/2017 Page 28 de 28 N° de révision : 01