ML20235P115
| ML20235P115 | |
| Person / Time | |
|---|---|
| Site: | 07002204 |
| Issue date: | 05/14/1976 |
| From: | Downer W BLODGETT MEMORIAL MEDICAL CENTER, GRAND RAPIDS, MI |
| To: | NRC |
| Shared Package | |
| ML20235N988 | List: |
| References | |
| 0843, 843, NUDOCS 8903020103 | |
| Download: ML20235P115 (2) | |
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R -aw BLODGETT MEMORIAL MEDICAL CENTER d
OR AND R APIDS. MICH10AN 49500 2
May 14, 1976
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St.5j ect : Amendment to License No. SNM 1614 for implantation of Nuclear powered pacemakers.
Dear Sir:
Since Blodgett Memorial Medical Center is licensed to implant Nuclear pacemakers under the license no. SNM 1614, expiration date March 31, 1981, we request an amendment for our license that would permit us to include the Cordia Nuclear Omni-Stanicor Model No. 184A, Catalog No. 307-C05. We will follow explicitly the master protocol, dated October 30, 1974, provided by the Cordis Corporation and approved by your office.
You can be assured that all institutional commitments previously submitted are binding. Any changes in this initial cormit-ment are enclosed.
If any additional forms or information are required, please notify us as soon as possible.
Signed:
Applicant:
Blodgettepmorial Medic 1 Center
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DilliamJ.))6wner,'jp President ['
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ATTACHMENT 1 INSTRUCTIONS FOR HOSPITAL OR CLINIC TELEPHONE OPERATORS CORATOMIC C-101 ISOTOPIC PULSE GENERATOR Pacemaker Coordinator-Marilyn Bale, R. N.
(616)-459-7258 PROJECT NUCLEAR PACEMAKER PROJECT NUCLEAR PACEMAKER Instructions to Operator:
1.
Accept any collect call with reference to " Project Nuclear Pacemaker".
2.
Any call concerning " Project Nuclear Pacemaker" involves a patient with a nuclear pacer and requires immediate action to. insure that there is no danger of radiation exposure and recovety of the nuclear pacer.
3.
Obtain as much information from the caller as is possible including:
Caller's Name and Were he may be reached.
Patient's Name, Status and Were he may be reached.
I Attending Physician (if any) and W ere he may be Reached.
Information from Patient I.D. Card Patient's Social Security No.
Date of Implant Pacer Serial Number 4.
Noeify immediately: Ibbnvh W. unvriann.
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n1 nann && %,-4 n1 m4mi center Grarti R,nian. Mi chi nnn. aonns tc1 cs _Ano_ neo (Name, address, telephone ndmber of physician r'esponsible for study)
If he cannot be reached, notify:
Pichard A. Pasmussen, M.
D., Blodgett Mnmnrin1 Snaien1 chntnv. 45906.
((616)-459-7258 (Name, address, telephone number of alternative physician).
If neither can be reached, contact physician on duty.for the Cardiac Care Unit; inform him that this involves a nuclear pacer; and advise him of the information you have and the urgency of the matter.
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