Therapieverlauf
Patient Passport
____________________________
Surname
_______________________________________________________________
Address
____________________________
Mask (model/size)
Course of Treatment
Initial results dated ____________: _________________________________________________________________________
Age ___________________years
Date
Setting on unit
CPAP/ASB
Pinsp:
Pexp:
Trigg.I:
Trigg.E:
Ramp:
0,
Alarm
active/inactive
ApnoeVent
AV latency:
AV freq.:
AV insp.:
*
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34
____________________________
First name
____________________________
Hood/harness size* Gr.
Weight
mbar
mbar
s
*
OFF/ON*
s
min
%
____________________________
Date of birth
____________________________
Tel.
____________________________
Accessories
Height________________cm
kg
Blood pressure