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General Information
Your Name
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List your Active Patients
Pacemaker
ICD
ILR
Number of Remote Checks Billed Last Year
93294
93295
93296
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93297
93298
G2066
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System Info
Device Database
EMR
Are you Currently Outsourcing?
Yes
No
If yes, please include details
Daily Numbers
Open Device Positions
Average Daily Scheduled
Average Daily Unscheduled
Number of Disconnected
Carelink
Latitude
Merlin
Biotronik
Number of No Future Schedules
Carelink
Latitude
Merlin
HF Monitoring
Yes
No
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