IMPORTANT INFORMATION TO RECORD
Your Name: ___________________________________________________________________
Date You Received Your Unit:_ ____________________________________________________
Prescribed Oxygen Flow Setting:
•At Rest:____________________________
•During Exercise:______________________
Home Care Provider’s Name:______________________________________________________
Home Care Provider’s Phone Number: (_______)______________________________________
Physician’s Name:______________________________________________________________
Physician’s Phone Number: (_______)______________________________________________
Notes: ___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
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