15. 2. 201714. 10. 2019 Miroslav Cihlo Primary Implantation SENSOR RESERVOIR®Registry Hospital name and Department nameHospital AddressDate of SENSOR RESERVOIR implantationSENSOR RESERVOIR ID numberInitial Pressure MeasurementsBefore implantation: to be measured in the sterile packaging before implantation Single measurement:Time of dayPressurePressurecm WSm barmm HgTorrhPaplease select the appropriate unitRemarkAfter implantationto be measured immediately after implantation and after wound closure in lying/recumbent positionTime of dayPressurePressurecm WSm barmm HgTorrhPaplease select the appropriate unitpulsatility visible?YesNoRemarkIf the SENSOR RESERVOIR was revised (surgically removed), please fill in the “REVISION” form.DateNameSignature E-mail This iframe contains the logic required to handle Ajax powered Gravity Forms.