Cardiac Resynchronization Therapy Defibrillator

Cardiac Resynchronization Therapy Defibrillator

Your CRT-D system information

Have your doctor or nurse complete these forms before you go home from the hospital. CRT-D Model Number:______________________________ CRT-D Serial Number: ______________________________ CRT-D Features: RF telemetry LATITUDE Implant Date: _____________________________________ Lead Model/Serial Numbers: _________________________ ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________

Your medical contact information

Electrophysiologist Name/Phone Number: ________________________________________________ Cardiologist Name/Phone Number: ________________________________________________ Hospital Name/Address/Phone Number: ________________________________________________ ________________________________________________ Medications (list): __________________________________ ________________________________________________ ________________________________________________

By Mail: Boston Scientific Corporation 4100 Hamline Avenue North St. Paul, Minnesota 55112-5798

By Telephone: Patients and families: 1.866.484.3268 Medical professionals: 1.800.CARDIAC (227.3422) Worldwide: 1.651.582.4000

On the Internet:

By E-mail: customercare@

Medical Records: 1.800.PATDATA (1.800.728.3282) 7 a.m.?7 p.m. (Central Time), Monday?Friday e-mail: medical.records@

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