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Submission: On March 16 via manual from US — Scanned from DE
Submission: On March 16 via manual from US — Scanned from DE
Form analysis 1 forms found in the DOM
Name: form — POST /redcap/surveys/index.php?s=yVELqTqsRytoSIu5
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<div data-mlm-field="tbl1" data-mlm-type="header">Cystoscope pan -does not include the power source</div>
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<td class="labelrc col-11" colspan="2">
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<div data-mlm-field="tbl1" data-mlm-type="label">
<div class="rich-text-field-label">
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<td style="height: 15pt; width: 48.4803%;" width="96" height="20"><span class="rc-field-embed" var="bridge_img" req="0"><span>
<div data-kind="field-label">
<div data-mlm-field="bridge_img" data-mlm-type="label"> Bridge, Telescope, Single, w/ 1 Lockable Channel n=1</div>
</div><br><br><img lsrc="/redcap/surveys/index.php?pid=10220&__passthru=DataEntry%2Fimage_view.php&doc_id_hash=503622c08b31a6360edad0cda29a443ce796c50c&id=240036&instance=1&s=yVELqTqsRytoSIu5"
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</span></span></td>
<td style="height: 34.5156px; width: 51.5197%;" width="96" height="20"><span class="rc-field-embed" var="bridge" req="0"><span data-kind="field-value"><input name="bridge" value="" tabindex="-1" class="hiddenradio"
aria-labelledby="label-bridge"><span class="choicehoriz"><input type="radio" id="opt-bridge_0" tabindex="0" name="bridge___radio" aria-labelledby="label-bridge label-bridge-0"
onclick="document.forms['form'].bridge.value=this.value;doBranching('bridge');" value="0"> <label data-mlm-field="bridge" data-mlm-type="enum" data-mlm-value="0" id="label-bridge-0" for="opt-bridge_0"
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onclick="document.forms['form'].bridge.value=this.value;doBranching('bridge');" value="1"> <label data-mlm-field="bridge" data-mlm-type="enum" data-mlm-value="1" id="label-bridge-1" for="opt-bridge_1"
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onclick="document.forms['form'].bridge.value=this.value;doBranching('bridge');" value="2"> <label data-mlm-field="bridge" data-mlm-type="enum" data-mlm-value="2" id="label-bridge-2" for="opt-bridge_2"
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onclick="document.forms['form'].bridge.value=this.value;doBranching('bridge');" value="3"> <label data-mlm-field="bridge" data-mlm-type="enum" data-mlm-value="3" id="label-bridge-3" for="opt-bridge_3"
class="mc">3</label></span><span class="choicehoriz"><input type="radio" id="opt-bridge_4" tabindex="0" name="bridge___radio" aria-labelledby="label-bridge label-bridge-4"
onclick="document.forms['form'].bridge.value=this.value;doBranching('bridge');" value="4"> <label data-mlm-field="bridge" data-mlm-type="enum" data-mlm-value="4" id="label-bridge-4" for="opt-bridge_4"
class="mc">4</label></span><span class="choicehoriz"><input type="radio" id="opt-bridge_5" tabindex="0" name="bridge___radio" aria-labelledby="label-bridge label-bridge-5"
onclick="document.forms['form'].bridge.value=this.value;doBranching('bridge');" value="5"> <label data-mlm-field="bridge" data-mlm-type="enum" data-mlm-value="5" id="label-bridge-5" for="opt-bridge_5"
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onclick="document.forms['form'].bridge.value=this.value;doBranching('bridge');" value="6"> <label data-mlm-field="bridge" data-mlm-type="enum" data-mlm-value="6" id="label-bridge-6" for="opt-bridge_6"
class="mc">6+</label></span></span>
<div data-kind="reset-link" class="resetLinkParent d-print-none">
<a href="javascript:;" class="smalllink " tabindex="0" style="display:;" onclick="radioResetVal('bridge','form');return false;"><span data-rc-lang="form_renderer_20">reset</span></a></div>
<div id="bridge_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
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<tr style="height: 43.75px;">
<td style="height: 15pt; width: 48.4803%;" height="20"><span class="rc-field-embed" var="bridge_2_img" req="0"><span>
<div data-kind="field-label">
<div data-mlm-field="bridge_2_img" data-mlm-type="label"> Bridge, Telescope, Double, w/ 2 Lockable Channels n=1</div>
</div><br><br><img lsrc="/redcap/surveys/index.php?pid=10220&__passthru=DataEntry%2Fimage_view.php&doc_id_hash=37e346eaa8d42eb9a2598ae6a797b6a328225e13&id=227583&instance=1&s=yVELqTqsRytoSIu5"
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<td style="height: 43.75px; width: 51.5197%;" height="20"><span class="rc-field-embed" var="bridge_2" req="0"><span data-kind="field-value"><input name="bridge_2" value="" tabindex="-1" class="hiddenradio"
aria-labelledby="label-bridge_2"><span class="choicehoriz"><input type="radio" id="opt-bridge_2_0" tabindex="0" name="bridge_2___radio" aria-labelledby="label-bridge_2 label-bridge_2-0"
onclick="document.forms['form'].bridge_2.value=this.value;doBranching('bridge_2');" value="0"> <label data-mlm-field="bridge_2" data-mlm-type="enum" data-mlm-value="0" id="label-bridge_2-0" for="opt-bridge_2_0"
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onclick="document.forms['form'].bridge_2.value=this.value;doBranching('bridge_2');" value="1"> <label data-mlm-field="bridge_2" data-mlm-type="enum" data-mlm-value="1" id="label-bridge_2-1" for="opt-bridge_2_1"
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onclick="document.forms['form'].bridge_2.value=this.value;doBranching('bridge_2');" value="2"> <label data-mlm-field="bridge_2" data-mlm-type="enum" data-mlm-value="2" id="label-bridge_2-2" for="opt-bridge_2_2"
class="mc">2</label></span><span class="choicehoriz"><input type="radio" id="opt-bridge_2_3" tabindex="0" name="bridge_2___radio" aria-labelledby="label-bridge_2 label-bridge_2-3"
onclick="document.forms['form'].bridge_2.value=this.value;doBranching('bridge_2');" value="3"> <label data-mlm-field="bridge_2" data-mlm-type="enum" data-mlm-value="3" id="label-bridge_2-3" for="opt-bridge_2_3"
class="mc">3</label></span><span class="choicehoriz"><input type="radio" id="opt-bridge_2_4" tabindex="0" name="bridge_2___radio" aria-labelledby="label-bridge_2 label-bridge_2-4"
onclick="document.forms['form'].bridge_2.value=this.value;doBranching('bridge_2');" value="4"> <label data-mlm-field="bridge_2" data-mlm-type="enum" data-mlm-value="4" id="label-bridge_2-4" for="opt-bridge_2_4"
class="mc">4</label></span><span class="choicehoriz"><input type="radio" id="opt-bridge_2_5" tabindex="0" name="bridge_2___radio" aria-labelledby="label-bridge_2 label-bridge_2-5"
onclick="document.forms['form'].bridge_2.value=this.value;doBranching('bridge_2');" value="5"> <label data-mlm-field="bridge_2" data-mlm-type="enum" data-mlm-value="5" id="label-bridge_2-5" for="opt-bridge_2_5"
class="mc">5</label></span><span class="choicehoriz"><input type="radio" id="opt-bridge_2_6" tabindex="0" name="bridge_2___radio" aria-labelledby="label-bridge_2 label-bridge_2-6"
onclick="document.forms['form'].bridge_2.value=this.value;doBranching('bridge_2');" value="6"> <label data-mlm-field="bridge_2" data-mlm-type="enum" data-mlm-value="6" id="label-bridge_2-6" for="opt-bridge_2_6"
class="mc">6+</label></span></span>
<div data-kind="reset-link" class="resetLinkParent d-print-none">
<a href="javascript:;" class="smalllink " tabindex="0" style="display:;" onclick="radioResetVal('bridge_2','form');return false;"><span data-rc-lang="form_renderer_20">reset</span></a></div>
<div id="bridge_2_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</span></td>
</tr>
<tr style="height: 34.5156px;">
<td style="height: 15pt; width: 48.4803%;" height="20"><span class="rc-field-embed" var="clcrst_img" req="0"><span>
<div data-kind="field-label">
<div data-mlm-field="clcrst_img" data-mlm-type="label"> Clamp, Crile, Straight, 5 1/2" n=1,</div>
</div><br><br><img lsrc="/redcap/surveys/index.php?pid=10220&__passthru=DataEntry%2Fimage_view.php&doc_id_hash=15776733c41adcbb998e5136ed5914e9ebe11d8b&id=240283&instance=1&s=yVELqTqsRytoSIu5"
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</span></span></td>
<td style="height: 34.5156px; width: 51.5197%;" height="20"><span class="rc-field-embed" var="clcrst" req="0"><span data-kind="field-value"><input name="clcrst" value="" tabindex="-1" class="hiddenradio"
aria-labelledby="label-clcrst"><span class="choicehoriz"><input type="radio" id="opt-clcrst_0" tabindex="0" name="clcrst___radio" aria-labelledby="label-clcrst label-clcrst-0"
onclick="document.forms['form'].clcrst.value=this.value;doBranching('clcrst');" value="0"> <label data-mlm-field="clcrst" data-mlm-type="enum" data-mlm-value="0" id="label-clcrst-0" for="opt-clcrst_0"
class="mc">0</label></span><span class="choicehoriz"><input type="radio" id="opt-clcrst_1" tabindex="0" name="clcrst___radio" aria-labelledby="label-clcrst label-clcrst-1"
onclick="document.forms['form'].clcrst.value=this.value;doBranching('clcrst');" value="1"> <label data-mlm-field="clcrst" data-mlm-type="enum" data-mlm-value="1" id="label-clcrst-1" for="opt-clcrst_1"
class="mc">1</label></span><span class="choicehoriz"><input type="radio" id="opt-clcrst_2" tabindex="0" name="clcrst___radio" aria-labelledby="label-clcrst label-clcrst-2"
onclick="document.forms['form'].clcrst.value=this.value;doBranching('clcrst');" value="2"> <label data-mlm-field="clcrst" data-mlm-type="enum" data-mlm-value="2" id="label-clcrst-2" for="opt-clcrst_2"
class="mc">2</label></span><span class="choicehoriz"><input type="radio" id="opt-clcrst_3" tabindex="0" name="clcrst___radio" aria-labelledby="label-clcrst label-clcrst-3"
onclick="document.forms['form'].clcrst.value=this.value;doBranching('clcrst');" value="3"> <label data-mlm-field="clcrst" data-mlm-type="enum" data-mlm-value="3" id="label-clcrst-3" for="opt-clcrst_3"
class="mc">3</label></span><span class="choicehoriz"><input type="radio" id="opt-clcrst_4" tabindex="0" name="clcrst___radio" aria-labelledby="label-clcrst label-clcrst-4"
onclick="document.forms['form'].clcrst.value=this.value;doBranching('clcrst');" value="4"> <label data-mlm-field="clcrst" data-mlm-type="enum" data-mlm-value="4" id="label-clcrst-4" for="opt-clcrst_4"
class="mc">4</label></span><span class="choicehoriz"><input type="radio" id="opt-clcrst_5" tabindex="0" name="clcrst___radio" aria-labelledby="label-clcrst label-clcrst-5"
onclick="document.forms['form'].clcrst.value=this.value;doBranching('clcrst');" value="5"> <label data-mlm-field="clcrst" data-mlm-type="enum" data-mlm-value="5" id="label-clcrst-5" for="opt-clcrst_5"
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onclick="document.forms['form'].clcrst.value=this.value;doBranching('clcrst');" value="6"> <label data-mlm-field="clcrst" data-mlm-type="enum" data-mlm-value="6" id="label-clcrst-6" for="opt-clcrst_6"
class="mc">6+</label></span></span>
<div data-kind="reset-link" class="resetLinkParent d-print-none">
<a href="javascript:;" class="smalllink " tabindex="0" style="display:;" onclick="radioResetVal('clcrst','form');return false;"><span data-rc-lang="form_renderer_20">reset</span></a></div>
<div id="clcrst_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</span></td>
</tr>
<tr style="height: 24.875px;">
<td style="height: 15pt; width: 48.4803%;" height="20"><span class="rc-field-embed" var="fcgropda_img" req="0"><span>
<div data-kind="field-label">
<div data-mlm-field="fcgropda_img" data-mlm-type="label"> Forceps, Biopsy, Double Action, Flexible, 9fr, 15 3/4"<br>
</div>
</div><br><br><img lsrc="/redcap/surveys/index.php?pid=10220&__passthru=DataEntry%2Fimage_view.php&doc_id_hash=17af608c3c62edc2cef94b5184c57f735575d09a&id=240041&instance=1&s=yVELqTqsRytoSIu5"
onload="fitImg(this);" alt="image" data-rc-lang-attrs="alt=survey_1140" style="width:250px;max-width:250px;height:245px;max-height:245px;" nativedim="1" class=""
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</span></span></td>
<td style="height: 24.875px; width: 51.5197%;" height="20"><span class="rc-field-embed" var="fcgropda" req="0"><span data-kind="field-value"><input name="fcgropda" value="" tabindex="-1" class="hiddenradio"
aria-labelledby="label-fcgropda"><span class="choicehoriz"><input type="radio" id="opt-fcgropda_0" tabindex="0" name="fcgropda___radio" aria-labelledby="label-fcgropda label-fcgropda-0"
onclick="document.forms['form'].fcgropda.value=this.value;doBranching('fcgropda');" value="0"> <label data-mlm-field="fcgropda" data-mlm-type="enum" data-mlm-value="0" id="label-fcgropda-0" for="opt-fcgropda_0"
class="mc">0</label></span><span class="choicehoriz"><input type="radio" id="opt-fcgropda_1" tabindex="0" name="fcgropda___radio" aria-labelledby="label-fcgropda label-fcgropda-1"
onclick="document.forms['form'].fcgropda.value=this.value;doBranching('fcgropda');" value="1"> <label data-mlm-field="fcgropda" data-mlm-type="enum" data-mlm-value="1" id="label-fcgropda-1" for="opt-fcgropda_1"
class="mc">1</label></span><span class="choicehoriz"><input type="radio" id="opt-fcgropda_2" tabindex="0" name="fcgropda___radio" aria-labelledby="label-fcgropda label-fcgropda-2"
onclick="document.forms['form'].fcgropda.value=this.value;doBranching('fcgropda');" value="2"> <label data-mlm-field="fcgropda" data-mlm-type="enum" data-mlm-value="2" id="label-fcgropda-2" for="opt-fcgropda_2"
class="mc">2</label></span><span class="choicehoriz"><input type="radio" id="opt-fcgropda_3" tabindex="0" name="fcgropda___radio" aria-labelledby="label-fcgropda label-fcgropda-3"
onclick="document.forms['form'].fcgropda.value=this.value;doBranching('fcgropda');" value="3"> <label data-mlm-field="fcgropda" data-mlm-type="enum" data-mlm-value="3" id="label-fcgropda-3" for="opt-fcgropda_3"
class="mc">3</label></span><span class="choicehoriz"><input type="radio" id="opt-fcgropda_4" tabindex="0" name="fcgropda___radio" aria-labelledby="label-fcgropda label-fcgropda-4"
onclick="document.forms['form'].fcgropda.value=this.value;doBranching('fcgropda');" value="4"> <label data-mlm-field="fcgropda" data-mlm-type="enum" data-mlm-value="4" id="label-fcgropda-4" for="opt-fcgropda_4"
class="mc">4</label></span><span class="choicehoriz"><input type="radio" id="opt-fcgropda_5" tabindex="0" name="fcgropda___radio" aria-labelledby="label-fcgropda label-fcgropda-5"
onclick="document.forms['form'].fcgropda.value=this.value;doBranching('fcgropda');" value="5"> <label data-mlm-field="fcgropda" data-mlm-type="enum" data-mlm-value="5" id="label-fcgropda-5" for="opt-fcgropda_5"
class="mc">5</label></span><span class="choicehoriz"><input type="radio" id="opt-fcgropda_6" tabindex="0" name="fcgropda___radio" aria-labelledby="label-fcgropda label-fcgropda-6"
onclick="document.forms['form'].fcgropda.value=this.value;doBranching('fcgropda');" value="6"> <label data-mlm-field="fcgropda" data-mlm-type="enum" data-mlm-value="6" id="label-fcgropda-6" for="opt-fcgropda_6"
class="mc">6+</label></span></span>
<div data-kind="reset-link" class="resetLinkParent d-print-none">
<a href="javascript:;" class="smalllink " tabindex="0" style="display:;" onclick="radioResetVal('fcgropda','form');return false;"><span data-rc-lang="form_renderer_20">reset</span></a></div>
<div id="fcgropda_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</span></td>
</tr>
<tr style="height: 24.875px;">
<td style="height: 15pt; width: 48.4803%;" height="20"><span class="rc-field-embed" var="fcgropda1_img" req="0"><span>
<div data-kind="field-label">
<div data-mlm-field="fcgropda1_img" data-mlm-type="label"> Forceps, Grasping, Optical, Double Action, 12" n=1</div>
</div><br><br><img lsrc="/redcap/surveys/index.php?pid=10220&__passthru=DataEntry%2Fimage_view.php&doc_id_hash=ea44301f86da21eecd19e3048397e13aecf9dc57&id=240042&instance=1&s=yVELqTqsRytoSIu5"
onload="fitImg(this);" alt="image" data-rc-lang-attrs="alt=survey_1140" style="width:250px;max-width:250px;height:250px;max-height:250px;" nativedim="1" class=""
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</span></span></td>
<td style="height: 24.875px; width: 51.5197%;" height="20"><span class="rc-field-embed" var="fcgropda1" req="0"><span data-kind="field-value"><input name="fcgropda1" value="" tabindex="-1" class="hiddenradio"
aria-labelledby="label-fcgropda1"><span class="choicehoriz"><input type="radio" id="opt-fcgropda1_0" tabindex="0" name="fcgropda1___radio" aria-labelledby="label-fcgropda1 label-fcgropda1-0"
onclick="document.forms['form'].fcgropda1.value=this.value;doBranching('fcgropda1');" value="0"> <label data-mlm-field="fcgropda1" data-mlm-type="enum" data-mlm-value="0" id="label-fcgropda1-0" for="opt-fcgropda1_0"
class="mc">0</label></span><span class="choicehoriz"><input type="radio" id="opt-fcgropda1_1" tabindex="0" name="fcgropda1___radio" aria-labelledby="label-fcgropda1 label-fcgropda1-1"
onclick="document.forms['form'].fcgropda1.value=this.value;doBranching('fcgropda1');" value="1"> <label data-mlm-field="fcgropda1" data-mlm-type="enum" data-mlm-value="1" id="label-fcgropda1-1" for="opt-fcgropda1_1"
class="mc">1</label></span><span class="choicehoriz"><input type="radio" id="opt-fcgropda1_2" tabindex="0" name="fcgropda1___radio" aria-labelledby="label-fcgropda1 label-fcgropda1-2"
onclick="document.forms['form'].fcgropda1.value=this.value;doBranching('fcgropda1');" value="2"> <label data-mlm-field="fcgropda1" data-mlm-type="enum" data-mlm-value="2" id="label-fcgropda1-2" for="opt-fcgropda1_2"
class="mc">2</label></span><span class="choicehoriz"><input type="radio" id="opt-fcgropda1_3" tabindex="0" name="fcgropda1___radio" aria-labelledby="label-fcgropda1 label-fcgropda1-3"
onclick="document.forms['form'].fcgropda1.value=this.value;doBranching('fcgropda1');" value="3"> <label data-mlm-field="fcgropda1" data-mlm-type="enum" data-mlm-value="3" id="label-fcgropda1-3" for="opt-fcgropda1_3"
class="mc">3</label></span><span class="choicehoriz"><input type="radio" id="opt-fcgropda1_4" tabindex="0" name="fcgropda1___radio" aria-labelledby="label-fcgropda1 label-fcgropda1-4"
onclick="document.forms['form'].fcgropda1.value=this.value;doBranching('fcgropda1');" value="4"> <label data-mlm-field="fcgropda1" data-mlm-type="enum" data-mlm-value="4" id="label-fcgropda1-4" for="opt-fcgropda1_4"
class="mc">4</label></span><span class="choicehoriz"><input type="radio" id="opt-fcgropda1_5" tabindex="0" name="fcgropda1___radio" aria-labelledby="label-fcgropda1 label-fcgropda1-5"
onclick="document.forms['form'].fcgropda1.value=this.value;doBranching('fcgropda1');" value="5"> <label data-mlm-field="fcgropda1" data-mlm-type="enum" data-mlm-value="5" id="label-fcgropda1-5" for="opt-fcgropda1_5"
class="mc">5</label></span><span class="choicehoriz"><input type="radio" id="opt-fcgropda1_6" tabindex="0" name="fcgropda1___radio" aria-labelledby="label-fcgropda1 label-fcgropda1-6"
onclick="document.forms['form'].fcgropda1.value=this.value;doBranching('fcgropda1');" value="6"> <label data-mlm-field="fcgropda1" data-mlm-type="enum" data-mlm-value="6" id="label-fcgropda1-6" for="opt-fcgropda1_6"
class="mc">6+</label></span></span>
<div data-kind="reset-link" class="resetLinkParent d-print-none">
<a href="javascript:;" class="smalllink " tabindex="0" style="display:;" onclick="radioResetVal('fcgropda1','form');return false;"><span data-rc-lang="form_renderer_20">reset</span></a></div>
<div id="fcgropda1_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</span></td>
</tr>
<tr style="height: 36px;">
<td style="height: 15pt; width: 48.4803%;" height="20"><span class="rc-field-embed" var="grada7_img" req="0"><span>
<div data-kind="field-label">
<div data-mlm-field="grada7_img" data-mlm-type="label"> Grasper, Alligator, Double Action, Flexible, 7fr, 15 3/4"<br>
</div>
</div><br><br><img lsrc="/redcap/surveys/index.php?pid=10220&__passthru=DataEntry%2Fimage_view.php&doc_id_hash=97aef3a6bc6ce5397a40df391613240791483b83&id=240047&instance=1&s=yVELqTqsRytoSIu5"
onload="fitImg(this);" alt="image" data-rc-lang-attrs="alt=survey_1140" style="width:250px;max-width:250px;height:250px;max-height:250px;" nativedim="1" class=""
src="/redcap/surveys/index.php?pid=10220&__passthru=DataEntry%2Fimage_view.php&doc_id_hash=97aef3a6bc6ce5397a40df391613240791483b83&id=240047&instance=1&s=yVELqTqsRytoSIu5">
</span></span></td>
<td style="height: 36px; width: 51.5197%;" height="20"><span class="rc-field-embed" var="grada7" req="0"><span data-kind="field-value"><input name="grada7" value="" tabindex="-1" class="hiddenradio"
aria-labelledby="label-grada7"><span class="choicehoriz"><input type="radio" id="opt-grada7_0" tabindex="0" name="grada7___radio" aria-labelledby="label-grada7 label-grada7-0"
onclick="document.forms['form'].grada7.value=this.value;doBranching('grada7');" value="0"> <label data-mlm-field="grada7" data-mlm-type="enum" data-mlm-value="0" id="label-grada7-0" for="opt-grada7_0"
class="mc">0</label></span><span class="choicehoriz"><input type="radio" id="opt-grada7_1" tabindex="0" name="grada7___radio" aria-labelledby="label-grada7 label-grada7-1"
onclick="document.forms['form'].grada7.value=this.value;doBranching('grada7');" value="1"> <label data-mlm-field="grada7" data-mlm-type="enum" data-mlm-value="1" id="label-grada7-1" for="opt-grada7_1"
class="mc">1</label></span><span class="choicehoriz"><input type="radio" id="opt-grada7_2" tabindex="0" name="grada7___radio" aria-labelledby="label-grada7 label-grada7-2"
onclick="document.forms['form'].grada7.value=this.value;doBranching('grada7');" value="2"> <label data-mlm-field="grada7" data-mlm-type="enum" data-mlm-value="2" id="label-grada7-2" for="opt-grada7_2"
class="mc">2</label></span><span class="choicehoriz"><input type="radio" id="opt-grada7_3" tabindex="0" name="grada7___radio" aria-labelledby="label-grada7 label-grada7-3"
onclick="document.forms['form'].grada7.value=this.value;doBranching('grada7');" value="3"> <label data-mlm-field="grada7" data-mlm-type="enum" data-mlm-value="3" id="label-grada7-3" for="opt-grada7_3"
class="mc">3</label></span><span class="choicehoriz"><input type="radio" id="opt-grada7_4" tabindex="0" name="grada7___radio" aria-labelledby="label-grada7 label-grada7-4"
onclick="document.forms['form'].grada7.value=this.value;doBranching('grada7');" value="4"> <label data-mlm-field="grada7" data-mlm-type="enum" data-mlm-value="4" id="label-grada7-4" for="opt-grada7_4"
class="mc">4</label></span><span class="choicehoriz"><input type="radio" id="opt-grada7_5" tabindex="0" name="grada7___radio" aria-labelledby="label-grada7 label-grada7-5"
onclick="document.forms['form'].grada7.value=this.value;doBranching('grada7');" value="5"> <label data-mlm-field="grada7" data-mlm-type="enum" data-mlm-value="5" id="label-grada7-5" for="opt-grada7_5"
class="mc">5</label></span><span class="choicehoriz"><input type="radio" id="opt-grada7_6" tabindex="0" name="grada7___radio" aria-labelledby="label-grada7 label-grada7-6"
onclick="document.forms['form'].grada7.value=this.value;doBranching('grada7');" value="6"> <label data-mlm-field="grada7" data-mlm-type="enum" data-mlm-value="6" id="label-grada7-6" for="opt-grada7_6"
class="mc">6+</label></span></span>
<div data-kind="reset-link" class="resetLinkParent d-print-none">
<a href="javascript:;" class="smalllink " tabindex="0" style="display:;" onclick="radioResetVal('grada7','form');return false;"><span data-rc-lang="form_renderer_20">reset</span></a></div>
<div id="grada7_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</span></td>
</tr>
<tr style="height: 24.875px;">
<td style="height: 15pt; width: 48.4803%;" height="20"><span class="rc-field-embed" var="ocu20fr_img" req="0"><span>
<div data-kind="field-label">
<div data-mlm-field="ocu20fr_img" data-mlm-type="label"> Obturator, Cystoscope-Urethroscope, 20fr n=1</div>
</div><br><br><img lsrc="/redcap/surveys/index.php?pid=10220&__passthru=DataEntry%2Fimage_view.php&doc_id_hash=c5602b0129aed4751c43ae6eb7cde0a2ea845ca1&id=240049&instance=1&s=yVELqTqsRytoSIu5"
onload="fitImg(this);" alt="image" data-rc-lang-attrs="alt=survey_1140" style="width:250px;max-width:250px;height:250px;max-height:250px;" nativedim="1" class=""
src="/redcap/surveys/index.php?pid=10220&__passthru=DataEntry%2Fimage_view.php&doc_id_hash=c5602b0129aed4751c43ae6eb7cde0a2ea845ca1&id=240049&instance=1&s=yVELqTqsRytoSIu5">
</span></span></td>
<td style="height: 24.875px; width: 51.5197%;" height="20"><span class="rc-field-embed" var="ocu20fr" req="0"><span data-kind="field-value"><input name="ocu20fr" value="" tabindex="-1" class="hiddenradio"
aria-labelledby="label-ocu20fr"><span class="choicehoriz"><input type="radio" id="opt-ocu20fr_0" tabindex="0" name="ocu20fr___radio" aria-labelledby="label-ocu20fr label-ocu20fr-0"
onclick="document.forms['form'].ocu20fr.value=this.value;doBranching('ocu20fr');" value="0"> <label data-mlm-field="ocu20fr" data-mlm-type="enum" data-mlm-value="0" id="label-ocu20fr-0" for="opt-ocu20fr_0"
class="mc">0</label></span><span class="choicehoriz"><input type="radio" id="opt-ocu20fr_1" tabindex="0" name="ocu20fr___radio" aria-labelledby="label-ocu20fr label-ocu20fr-1"
onclick="document.forms['form'].ocu20fr.value=this.value;doBranching('ocu20fr');" value="1"> <label data-mlm-field="ocu20fr" data-mlm-type="enum" data-mlm-value="1" id="label-ocu20fr-1" for="opt-ocu20fr_1"
class="mc">1</label></span><span class="choicehoriz"><input type="radio" id="opt-ocu20fr_2" tabindex="0" name="ocu20fr___radio" aria-labelledby="label-ocu20fr label-ocu20fr-2"
onclick="document.forms['form'].ocu20fr.value=this.value;doBranching('ocu20fr');" value="2"> <label data-mlm-field="ocu20fr" data-mlm-type="enum" data-mlm-value="2" id="label-ocu20fr-2" for="opt-ocu20fr_2"
class="mc">2</label></span><span class="choicehoriz"><input type="radio" id="opt-ocu20fr_3" tabindex="0" name="ocu20fr___radio" aria-labelledby="label-ocu20fr label-ocu20fr-3"
onclick="document.forms['form'].ocu20fr.value=this.value;doBranching('ocu20fr');" value="3"> <label data-mlm-field="ocu20fr" data-mlm-type="enum" data-mlm-value="3" id="label-ocu20fr-3" for="opt-ocu20fr_3"
class="mc">3</label></span><span class="choicehoriz"><input type="radio" id="opt-ocu20fr_4" tabindex="0" name="ocu20fr___radio" aria-labelledby="label-ocu20fr label-ocu20fr-4"
onclick="document.forms['form'].ocu20fr.value=this.value;doBranching('ocu20fr');" value="4"> <label data-mlm-field="ocu20fr" data-mlm-type="enum" data-mlm-value="4" id="label-ocu20fr-4" for="opt-ocu20fr_4"
class="mc">4</label></span><span class="choicehoriz"><input type="radio" id="opt-ocu20fr_5" tabindex="0" name="ocu20fr___radio" aria-labelledby="label-ocu20fr label-ocu20fr-5"
onclick="document.forms['form'].ocu20fr.value=this.value;doBranching('ocu20fr');" value="5"> <label data-mlm-field="ocu20fr" data-mlm-type="enum" data-mlm-value="5" id="label-ocu20fr-5" for="opt-ocu20fr_5"
class="mc">5</label></span><span class="choicehoriz"><input type="radio" id="opt-ocu20fr_6" tabindex="0" name="ocu20fr___radio" aria-labelledby="label-ocu20fr label-ocu20fr-6"
onclick="document.forms['form'].ocu20fr.value=this.value;doBranching('ocu20fr');" value="6"> <label data-mlm-field="ocu20fr" data-mlm-type="enum" data-mlm-value="6" id="label-ocu20fr-6" for="opt-ocu20fr_6"
class="mc">6+</label></span></span>
<div data-kind="reset-link" class="resetLinkParent d-print-none">
<a href="javascript:;" class="smalllink " tabindex="0" style="display:;" onclick="radioResetVal('ocu20fr','form');return false;"><span data-rc-lang="form_renderer_20">reset</span></a></div>
<div id="ocu20fr_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</span></td>
</tr>
<tr style="height: 24.875px;">
<td style="height: 15pt; width: 48.4803%;" height="20"><span class="rc-field-embed" var="ocu2212_img" req="0"><span>
<div data-kind="field-label">
<div data-mlm-field="ocu2212_img" data-mlm-type="label"> Obturator, Cystoscope-Urethroscope, 22fr 12" n=1</div>
</div><br><br><img lsrc="/redcap/surveys/index.php?pid=10220&__passthru=DataEntry%2Fimage_view.php&doc_id_hash=5e37e291417cf066e58b93894a8ca8a7c5a2311e&id=240053&instance=1&s=yVELqTqsRytoSIu5"
onload="fitImg(this);" alt="image" data-rc-lang-attrs="alt=survey_1140" style="width:250px;max-width:250px;height:250px;max-height:250px;" nativedim="1" class=""
src="/redcap/surveys/index.php?pid=10220&__passthru=DataEntry%2Fimage_view.php&doc_id_hash=5e37e291417cf066e58b93894a8ca8a7c5a2311e&id=240053&instance=1&s=yVELqTqsRytoSIu5">
</span></span></td>
<td style="height: 24.875px; width: 51.5197%;" height="20"><span class="rc-field-embed" var="ocu2212" req="0"><span data-kind="field-value"><input name="ocu2212" value="" tabindex="-1" class="hiddenradio"
aria-labelledby="label-ocu2212"><span class="choicehoriz"><input type="radio" id="opt-ocu2212_0" tabindex="0" name="ocu2212___radio" aria-labelledby="label-ocu2212 label-ocu2212-0"
onclick="document.forms['form'].ocu2212.value=this.value;doBranching('ocu2212');" value="0"> <label data-mlm-field="ocu2212" data-mlm-type="enum" data-mlm-value="0" id="label-ocu2212-0" for="opt-ocu2212_0"
class="mc">0</label></span><span class="choicehoriz"><input type="radio" id="opt-ocu2212_1" tabindex="0" name="ocu2212___radio" aria-labelledby="label-ocu2212 label-ocu2212-1"
onclick="document.forms['form'].ocu2212.value=this.value;doBranching('ocu2212');" value="1"> <label data-mlm-field="ocu2212" data-mlm-type="enum" data-mlm-value="1" id="label-ocu2212-1" for="opt-ocu2212_1"
class="mc">1</label></span><span class="choicehoriz"><input type="radio" id="opt-ocu2212_2" tabindex="0" name="ocu2212___radio" aria-labelledby="label-ocu2212 label-ocu2212-2"
onclick="document.forms['form'].ocu2212.value=this.value;doBranching('ocu2212');" value="2"> <label data-mlm-field="ocu2212" data-mlm-type="enum" data-mlm-value="2" id="label-ocu2212-2" for="opt-ocu2212_2"
class="mc">2</label></span><span class="choicehoriz"><input type="radio" id="opt-ocu2212_3" tabindex="0" name="ocu2212___radio" aria-labelledby="label-ocu2212 label-ocu2212-3"
onclick="document.forms['form'].ocu2212.value=this.value;doBranching('ocu2212');" value="3"> <label data-mlm-field="ocu2212" data-mlm-type="enum" data-mlm-value="3" id="label-ocu2212-3" for="opt-ocu2212_3"
class="mc">3</label></span><span class="choicehoriz"><input type="radio" id="opt-ocu2212_4" tabindex="0" name="ocu2212___radio" aria-labelledby="label-ocu2212 label-ocu2212-4"
onclick="document.forms['form'].ocu2212.value=this.value;doBranching('ocu2212');" value="4"> <label data-mlm-field="ocu2212" data-mlm-type="enum" data-mlm-value="4" id="label-ocu2212-4" for="opt-ocu2212_4"
class="mc">4</label></span><span class="choicehoriz"><input type="radio" id="opt-ocu2212_5" tabindex="0" name="ocu2212___radio" aria-labelledby="label-ocu2212 label-ocu2212-5"
onclick="document.forms['form'].ocu2212.value=this.value;doBranching('ocu2212');" value="5"> <label data-mlm-field="ocu2212" data-mlm-type="enum" data-mlm-value="5" id="label-ocu2212-5" for="opt-ocu2212_5"
class="mc">5</label></span><span class="choicehoriz"><input type="radio" id="opt-ocu2212_6" tabindex="0" name="ocu2212___radio" aria-labelledby="label-ocu2212 label-ocu2212-6"
onclick="document.forms['form'].ocu2212.value=this.value;doBranching('ocu2212');" value="6"> <label data-mlm-field="ocu2212" data-mlm-type="enum" data-mlm-value="6" id="label-ocu2212-6" for="opt-ocu2212_6"
class="mc">6+</label></span></span>
<div data-kind="reset-link" class="resetLinkParent d-print-none">
<a href="javascript:;" class="smalllink " tabindex="0" style="display:;" onclick="radioResetVal('ocu2212','form');return false;"><span data-rc-lang="form_renderer_20">reset</span></a></div>
<div id="ocu2212_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</span></td>
</tr>
<tr style="height: 24.875px;">
<td style="height: 15pt; width: 48.4803%;" height="20"><span class="rc-field-embed" var="smds63q_img" req="0"><span>
<div data-kind="field-label">
<div data-mlm-field="smds63q_img" data-mlm-type="label"> Scissors, Mayo, Dissecting, Straight, 6 3/4" n=1</div>
</div><br><br><img lsrc="/redcap/surveys/index.php?pid=10220&__passthru=DataEntry%2Fimage_view.php&doc_id_hash=b001f7f64717c2fab46ccbfe8ef6694bd37d5c32&id=240054&instance=1&s=yVELqTqsRytoSIu5"
onload="fitImg(this);" alt="image" data-rc-lang-attrs="alt=survey_1140" style="width:250px;max-width:250px;height:252px;max-height:252px;" nativedim="1" class=""
src="/redcap/surveys/index.php?pid=10220&__passthru=DataEntry%2Fimage_view.php&doc_id_hash=b001f7f64717c2fab46ccbfe8ef6694bd37d5c32&id=240054&instance=1&s=yVELqTqsRytoSIu5">
</span></span></td>
<td style="height: 24.875px; width: 51.5197%;" height="20"><span class="rc-field-embed" var="smds63q" req="0"><span data-kind="field-value"><input name="smds63q" value="" tabindex="-1" class="hiddenradio"
aria-labelledby="label-smds63q"><span class="choicehoriz"><input type="radio" id="opt-smds63q_0" tabindex="0" name="smds63q___radio" aria-labelledby="label-smds63q label-smds63q-0"
onclick="document.forms['form'].smds63q.value=this.value;doBranching('smds63q');" value="0"> <label data-mlm-field="smds63q" data-mlm-type="enum" data-mlm-value="0" id="label-smds63q-0" for="opt-smds63q_0"
class="mc">0</label></span><span class="choicehoriz"><input type="radio" id="opt-smds63q_1" tabindex="0" name="smds63q___radio" aria-labelledby="label-smds63q label-smds63q-1"
onclick="document.forms['form'].smds63q.value=this.value;doBranching('smds63q');" value="1"> <label data-mlm-field="smds63q" data-mlm-type="enum" data-mlm-value="1" id="label-smds63q-1" for="opt-smds63q_1"
class="mc">1</label></span><span class="choicehoriz"><input type="radio" id="opt-smds63q_2" tabindex="0" name="smds63q___radio" aria-labelledby="label-smds63q label-smds63q-2"
onclick="document.forms['form'].smds63q.value=this.value;doBranching('smds63q');" value="2"> <label data-mlm-field="smds63q" data-mlm-type="enum" data-mlm-value="2" id="label-smds63q-2" for="opt-smds63q_2"
class="mc">2</label></span><span class="choicehoriz"><input type="radio" id="opt-smds63q_3" tabindex="0" name="smds63q___radio" aria-labelledby="label-smds63q label-smds63q-3"
onclick="document.forms['form'].smds63q.value=this.value;doBranching('smds63q');" value="3"> <label data-mlm-field="smds63q" data-mlm-type="enum" data-mlm-value="3" id="label-smds63q-3" for="opt-smds63q_3"
class="mc">3</label></span><span class="choicehoriz"><input type="radio" id="opt-smds63q_4" tabindex="0" name="smds63q___radio" aria-labelledby="label-smds63q label-smds63q-4"
onclick="document.forms['form'].smds63q.value=this.value;doBranching('smds63q');" value="4"> <label data-mlm-field="smds63q" data-mlm-type="enum" data-mlm-value="4" id="label-smds63q-4" for="opt-smds63q_4"
class="mc">4</label></span><span class="choicehoriz"><input type="radio" id="opt-smds63q_5" tabindex="0" name="smds63q___radio" aria-labelledby="label-smds63q label-smds63q-5"
onclick="document.forms['form'].smds63q.value=this.value;doBranching('smds63q');" value="5"> <label data-mlm-field="smds63q" data-mlm-type="enum" data-mlm-value="5" id="label-smds63q-5" for="opt-smds63q_5"
class="mc">5</label></span><span class="choicehoriz"><input type="radio" id="opt-smds63q_6" tabindex="0" name="smds63q___radio" aria-labelledby="label-smds63q label-smds63q-6"
onclick="document.forms['form'].smds63q.value=this.value;doBranching('smds63q');" value="6"> <label data-mlm-field="smds63q" data-mlm-type="enum" data-mlm-value="6" id="label-smds63q-6" for="opt-smds63q_6"
class="mc">6+</label></span></span>
<div data-kind="reset-link" class="resetLinkParent d-print-none">
<a href="javascript:;" class="smalllink " tabindex="0" style="display:;" onclick="radioResetVal('smds63q','form');return false;"><span data-rc-lang="form_renderer_20">reset</span></a></div>
<div id="smds63q_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</span></td>
</tr>
<tr style="height: 24.9219px;">
<td style="height: 15pt; width: 48.4803%;" height="20"><span class="rc-field-embed" var="tcbl51n_img" req="0"><span>
<div data-kind="field-label">
<div data-mlm-field="tcbl51n_img" data-mlm-type="label"> Towel Clip, Backhaus, Large, 5 1/4" n=1<br>
</div>
</div><br><br><img lsrc="/redcap/surveys/index.php?pid=10220&__passthru=DataEntry%2Fimage_view.php&doc_id_hash=a18735738666d0228c53ca0962906eaabe757d0b&id=240285&instance=1&s=yVELqTqsRytoSIu5"
onload="fitImg(this);" alt="image" data-rc-lang-attrs="alt=survey_1140" style="width:225px;max-width:225px;height:225px;max-height:225px;" nativedim="1" class=""
src="/redcap/surveys/index.php?pid=10220&__passthru=DataEntry%2Fimage_view.php&doc_id_hash=a18735738666d0228c53ca0962906eaabe757d0b&id=240285&instance=1&s=yVELqTqsRytoSIu5">
</span></span></td>
<td style="height: 24.9219px; width: 51.5197%;" height="20"><span class="rc-field-embed" var="tcbl51n" req="0"><span data-kind="field-value"><input name="tcbl51n" value="" tabindex="-1" class="hiddenradio"
aria-labelledby="label-tcbl51n"><span class="choicehoriz"><input type="radio" id="opt-tcbl51n_0" tabindex="0" name="tcbl51n___radio" aria-labelledby="label-tcbl51n label-tcbl51n-0"
onclick="document.forms['form'].tcbl51n.value=this.value;doBranching('tcbl51n');" value="0"> <label data-mlm-field="tcbl51n" data-mlm-type="enum" data-mlm-value="0" id="label-tcbl51n-0" for="opt-tcbl51n_0"
class="mc">0</label></span><span class="choicehoriz"><input type="radio" id="opt-tcbl51n_1" tabindex="0" name="tcbl51n___radio" aria-labelledby="label-tcbl51n label-tcbl51n-1"
onclick="document.forms['form'].tcbl51n.value=this.value;doBranching('tcbl51n');" value="1"> <label data-mlm-field="tcbl51n" data-mlm-type="enum" data-mlm-value="1" id="label-tcbl51n-1" for="opt-tcbl51n_1"
class="mc">1</label></span><span class="choicehoriz"><input type="radio" id="opt-tcbl51n_2" tabindex="0" name="tcbl51n___radio" aria-labelledby="label-tcbl51n label-tcbl51n-2"
onclick="document.forms['form'].tcbl51n.value=this.value;doBranching('tcbl51n');" value="2"> <label data-mlm-field="tcbl51n" data-mlm-type="enum" data-mlm-value="2" id="label-tcbl51n-2" for="opt-tcbl51n_2"
class="mc">2</label></span><span class="choicehoriz"><input type="radio" id="opt-tcbl51n_3" tabindex="0" name="tcbl51n___radio" aria-labelledby="label-tcbl51n label-tcbl51n-3"
onclick="document.forms['form'].tcbl51n.value=this.value;doBranching('tcbl51n');" value="3"> <label data-mlm-field="tcbl51n" data-mlm-type="enum" data-mlm-value="3" id="label-tcbl51n-3" for="opt-tcbl51n_3"
class="mc">3</label></span><span class="choicehoriz"><input type="radio" id="opt-tcbl51n_4" tabindex="0" name="tcbl51n___radio" aria-labelledby="label-tcbl51n label-tcbl51n-4"
onclick="document.forms['form'].tcbl51n.value=this.value;doBranching('tcbl51n');" value="4"> <label data-mlm-field="tcbl51n" data-mlm-type="enum" data-mlm-value="4" id="label-tcbl51n-4" for="opt-tcbl51n_4"
class="mc">4</label></span><span class="choicehoriz"><input type="radio" id="opt-tcbl51n_5" tabindex="0" name="tcbl51n___radio" aria-labelledby="label-tcbl51n label-tcbl51n-5"
onclick="document.forms['form'].tcbl51n.value=this.value;doBranching('tcbl51n');" value="5"> <label data-mlm-field="tcbl51n" data-mlm-type="enum" data-mlm-value="5" id="label-tcbl51n-5" for="opt-tcbl51n_5"
class="mc">5</label></span><span class="choicehoriz"><input type="radio" id="opt-tcbl51n_6" tabindex="0" name="tcbl51n___radio" aria-labelledby="label-tcbl51n label-tcbl51n-6"
onclick="document.forms['form'].tcbl51n.value=this.value;doBranching('tcbl51n');" value="6"> <label data-mlm-field="tcbl51n" data-mlm-type="enum" data-mlm-value="6" id="label-tcbl51n-6" for="opt-tcbl51n_6"
class="mc">6+</label></span></span>
<div data-kind="reset-link" class="resetLinkParent d-print-none">
<a href="javascript:;" class="smalllink " tabindex="0" style="display:;" onclick="radioResetVal('tcbl51n','form');return false;"><span data-rc-lang="form_renderer_20">reset</span></a></div>
<div id="tcbl51n_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</span></td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
</td>
</tr>
<tr class="hide row-field-embedded" id="bridge-tr" sq_id="bridge">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="fl" id="label-bridge">
<div data-kind="field-label">
<div data-mlm-field="bridge" data-mlm-type="label"> Bridge, Telescope, Single, w/ 1 Lockable Channel n=1</div>
</div>
</label></td>
<td class="data col-5"></td>
</tr>
<tr class="hide row-field-embedded" id="bridge_2-tr" sq_id="bridge_2">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="fl" id="label-bridge_2">
<div data-kind="field-label">
<div data-mlm-field="bridge_2" data-mlm-type="label"> Bridge, Telescope, Double, w/ 2 Lockable Channels n=1</div>
</div>
</label></td>
<td class="data col-5"></td>
</tr>
<tr class="hide row-field-embedded" id="clcrst-tr" sq_id="clcrst">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="fl" id="label-clcrst">
<div data-kind="field-label">
<div data-mlm-field="clcrst" data-mlm-type="label"> Clamp, Crile, Straight, 5 1/2" n=1,</div>
</div>
</label></td>
<td class="data col-5"></td>
</tr>
<tr class="hide row-field-embedded" id="fcgropda-tr" sq_id="fcgropda">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="fl" id="label-fcgropda">
<div data-kind="field-label">
<div data-mlm-field="fcgropda" data-mlm-type="label"> Forceps, Biopsy, Double Action, Flexible, 9fr, 15 3/4"<br>
</div>
</div>
</label></td>
<td class="data col-5"></td>
</tr>
<tr class="hide row-field-embedded" id="fcgropda1-tr" sq_id="fcgropda1">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="fl" id="label-fcgropda1">
<div data-kind="field-label">
<div data-mlm-field="fcgropda1" data-mlm-type="label"> Forceps, Grasping, Optical, Double Action, 12" n=1</div>
</div>
</label></td>
<td class="data col-5"></td>
</tr>
<tr class="hide row-field-embedded" id="grada7-tr" sq_id="grada7">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="fl" id="label-grada7">
<div data-kind="field-label">
<div data-mlm-field="grada7" data-mlm-type="label"> Grasper, Alligator, Double Action, Flexible, 7fr, 15 3/4"<br>
</div>
</div>
</label></td>
<td class="data col-5"></td>
</tr>
<tr class="hide row-field-embedded" id="ocu20fr-tr" sq_id="ocu20fr">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="fl" id="label-ocu20fr">
<div data-kind="field-label">
<div data-mlm-field="ocu20fr" data-mlm-type="label"> Obturator, Cystoscope-Urethroscope, 20fr n=1</div>
</div>
</label></td>
<td class="data col-5"></td>
</tr>
<tr class="hide row-field-embedded" id="ocu2212-tr" sq_id="ocu2212">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="fl" id="label-ocu2212">
<div data-kind="field-label">
<div data-mlm-field="ocu2212" data-mlm-type="label"> Obturator, Cystoscope-Urethroscope, 22fr 12" n=1</div>
</div>
</label></td>
<td class="data col-5"></td>
</tr>
<tr class="hide row-field-embedded" id="smds63q-tr" sq_id="smds63q">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="fl" id="label-smds63q">
<div data-kind="field-label">
<div data-mlm-field="smds63q" data-mlm-type="label"> Scissors, Mayo, Dissecting, Straight, 6 3/4" n=1</div>
</div>
</label></td>
<td class="data col-5"></td>
</tr>
<tr class="hide row-field-embedded" id="tcbl51n-tr" sq_id="tcbl51n">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="fl" id="label-tcbl51n">
<div data-kind="field-label">
<div data-mlm-field="tcbl51n" data-mlm-type="label"> Towel Clip, Backhaus, Large, 5 1/4" n=1<br>
</div>
</div>
</label></td>
<td class="data col-5"></td>
</tr>
<tr class="hide row-field-embedded" id="bridge_img-tr" sq_id="bridge_img">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-11" colspan="2"></td>
</tr>
<tr class="hide row-field-embedded" id="bridge_2_img-tr" sq_id="bridge_2_img">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-11" colspan="2"></td>
</tr>
<tr class="hide row-field-embedded" id="clcrst_img-tr" sq_id="clcrst_img">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-11" colspan="2"></td>
</tr>
<tr class="hide row-field-embedded" id="fcgropda_img-tr" sq_id="fcgropda_img">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-11" colspan="2"></td>
</tr>
<tr class="hide row-field-embedded" id="fcgropda1_img-tr" sq_id="fcgropda1_img">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-11" colspan="2"></td>
</tr>
<tr class="hide row-field-embedded" id="grada7_img-tr" sq_id="grada7_img">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-11" colspan="2"></td>
</tr>
<tr class="hide row-field-embedded" id="ocu20fr_img-tr" sq_id="ocu20fr_img">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-11" colspan="2"></td>
</tr>
<tr class="hide row-field-embedded" id="ocu2212_img-tr" sq_id="ocu2212_img">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-11" colspan="2"></td>
</tr>
<tr class="hide row-field-embedded" id="smds63q_img-tr" sq_id="smds63q_img">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-11" colspan="2"></td>
</tr>
<tr id="bridge_6-tr" sq_id="bridge_6" style="display: none;">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="fl" id="label-bridge_6">
<div data-kind="field-label">
<div data-mlm-field="bridge_6" data-mlm-type="label"> Exact quantity needed of: Bridge, Telescope, Single, w/ 1 Lockable Channel n=1</div>
</div>
</label></td>
<td class="data col-5"><span data-kind="field-value"><input autocomplete="new-password" aria-labelledby="label-bridge_6" class="x-form-text x-form-field " type="text" name="bridge_6" value="" tabindex="0"></span>
<div id="bridge_6_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</td>
</tr>
<tr class="hide row-field-embedded" id="tcbl51n_img-tr" sq_id="tcbl51n_img">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-11" colspan="2"></td>
</tr>
<tr id="bridge_2_6-tr" sq_id="bridge_2_6" style="display: none;">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="fl" id="label-bridge_2_6">
<div data-kind="field-label">
<div data-mlm-field="bridge_2_6" data-mlm-type="label"> Exact quantity needed of: Bridge, Telescope, Double, w/ 2 Lockable Channels n=1</div>
</div>
</label></td>
<td class="data col-5"><span data-kind="field-value"><input autocomplete="new-password" aria-labelledby="label-bridge_2_6" class="x-form-text x-form-field " type="text" name="bridge_2_6" value="" tabindex="0"></span>
<div id="bridge_2_6_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</td>
</tr>
<tr id="clcrst_6-tr" sq_id="clcrst_6" style="display: none;">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="fl" id="label-clcrst_6">
<div data-kind="field-label">
<div data-mlm-field="clcrst_6" data-mlm-type="label"> Exact quantity needed of: Clamp, Crile, Straight, 5 1/2" n=1,</div>
</div>
</label></td>
<td class="data col-5"><span data-kind="field-value"><input autocomplete="new-password" aria-labelledby="label-clcrst_6" class="x-form-text x-form-field " type="text" name="clcrst_6" value="" tabindex="0"></span>
<div id="clcrst_6_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</td>
</tr>
<tr id="fcgropda_6-tr" sq_id="fcgropda_6" style="display: none;">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="fl" id="label-fcgropda_6">
<div data-kind="field-label">
<div data-mlm-field="fcgropda_6" data-mlm-type="label"> Exact quantity needed of: Forceps, Biopsy, Double Action, Flexible, 9fr, 15 3/4"<br>
</div>
</div>
</label></td>
<td class="data col-5"><span data-kind="field-value"><input autocomplete="new-password" aria-labelledby="label-fcgropda_6" class="x-form-text x-form-field " type="text" name="fcgropda_6" value="" tabindex="0"></span>
<div id="fcgropda_6_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</td>
</tr>
<tr id="fcgropda1_6-tr" sq_id="fcgropda1_6" style="display: none;">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="fl" id="label-fcgropda1_6">
<div data-kind="field-label">
<div data-mlm-field="fcgropda1_6" data-mlm-type="label"> Exact quantity needed of: Forceps, Grasping, Optical, Double Action, 12" n=1</div>
</div>
</label></td>
<td class="data col-5"><span data-kind="field-value"><input autocomplete="new-password" aria-labelledby="label-fcgropda1_6" class="x-form-text x-form-field " type="text" name="fcgropda1_6" value="" tabindex="0"></span>
<div id="fcgropda1_6_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</td>
</tr>
<tr id="grada7_6-tr" sq_id="grada7_6" style="display: none;">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="fl" id="label-grada7_6">
<div data-kind="field-label">
<div data-mlm-field="grada7_6" data-mlm-type="label"> Exact quantity needed of: Grasper, Alligator, Double Action, Flexible, 7fr, 15 3/4"<br>
</div>
</div>
</label></td>
<td class="data col-5"><span data-kind="field-value"><input autocomplete="new-password" aria-labelledby="label-grada7_6" class="x-form-text x-form-field " type="text" name="grada7_6" value="" tabindex="0"></span>
<div id="grada7_6_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</td>
</tr>
<tr id="ocu20fr_6-tr" sq_id="ocu20fr_6" style="display: none;">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="fl" id="label-ocu20fr_6">
<div data-kind="field-label">
<div data-mlm-field="ocu20fr_6" data-mlm-type="label"> Exact quantity needed of: Obturator, Cystoscope-Urethroscope, 20fr n=1</div>
</div>
</label></td>
<td class="data col-5"><span data-kind="field-value"><input autocomplete="new-password" aria-labelledby="label-ocu20fr_6" class="x-form-text x-form-field " type="text" name="ocu20fr_6" value="" tabindex="0"></span>
<div id="ocu20fr_6_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</td>
</tr>
<tr id="ocu2212_6-tr" sq_id="ocu2212_6" style="display: none;">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="fl" id="label-ocu2212_6">
<div data-kind="field-label">
<div data-mlm-field="ocu2212_6" data-mlm-type="label"> Exact quantity needed of: Obturator, Cystoscope-Urethroscope, 22fr 12" n=1</div>
</div>
</label></td>
<td class="data col-5"><span data-kind="field-value"><input autocomplete="new-password" aria-labelledby="label-ocu2212_6" class="x-form-text x-form-field " type="text" name="ocu2212_6" value="" tabindex="0"></span>
<div id="ocu2212_6_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</td>
</tr>
<tr id="smds63q_6-tr" sq_id="smds63q_6" style="display: none;">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="fl" id="label-smds63q_6">
<div data-kind="field-label">
<div data-mlm-field="smds63q_6" data-mlm-type="label"> Exact quantity needed of: Scissors, Mayo, Dissecting, Straight, 6 3/4" n=1</div>
</div>
</label></td>
<td class="data col-5"><span data-kind="field-value"><input autocomplete="new-password" aria-labelledby="label-smds63q_6" class="x-form-text x-form-field " type="text" name="smds63q_6" value="" tabindex="0"></span>
<div id="smds63q_6_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</td>
</tr>
<tr id="tcbl51n_6-tr" sq_id="tcbl51n_6" style="display: none;">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-6"><label class="fl" id="label-tcbl51n_6">
<div data-kind="field-label">
<div data-mlm-field="tcbl51n_6" data-mlm-type="label"> Exact quantity needed of: Towel Clip, Backhaus, Large, 5 1/4" n=1<br>
</div>
</div>
</label></td>
<td class="data col-5"><span data-kind="field-value"><input autocomplete="new-password" aria-labelledby="label-tcbl51n_6" class="x-form-text x-form-field " type="text" name="tcbl51n_6" value="" tabindex="0"></span>
<div id="tcbl51n_6_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</td>
</tr>
<tr id="lsa1-tr" sq_id="lsa1">
<td class="labelrc questionnum col-1" valign="top"></td>
<td class="labelrc col-11" colspan="2"><label class="fl" id="label-lsa1">
<div data-kind="field-label">
<div data-mlm-field="lsa1" data-mlm-type="label"> List suggested additional items with qnty of each to add . If the specific name is unknown, enter as much detail including size or image</div>
</div>
</label>
<div class="space"></div><span data-kind="field-value">
<textarea autocomplete="new-password" class="x-form-field notesbox" aria-labelledby="label-lsa1" id="lsa1" name="lsa1" rc-align="left" tabindex="0"></textarea></span>
<div id="lsa1-expand" class="expandLinkParent d-print-none">
<a href="javascript:;" tabindex="-1" class="expandLink" onclick="growTextarea('lsa1')"><span data-rc-lang="form_renderer_19">Expand</span></a>
</div>
<div id="lsa1_MDLabel" class="MDLabel" style="display:none" code="" label=""></div>
</td>
</tr>
<input type="hidden" name="submit-action" id="submit-action" value="<span data-rc-lang="data_entry_206">Save Record</span>">
<input type="hidden" name="__start_time__" id="__start_time__" value="2023-03-16 17:02:56">
<input type="hidden" name="record_id" id="record_id" value="44">
<input type="hidden" name="__page__" value="1">
<input type="hidden" name="__page_hash__" value="bef8098857376199291d82d56ba0007e">
<input type="hidden" name="__response_hash__" value="">
<input type="hidden" name="cystoscope_pan_survey_complete" value="">
<tr class="surveysubmit">
<td class="labelrc col-12" style="padding:5px;" colspan="3">
<table cellspacing="0">
<tbody>
<tr>
<td colspan="2" style="text-align:center;padding:15px 0;">
<button name="submit-btn-saverecord" tabindex="0" class="jqbutton nowrap ui-button ui-corner-all ui-widget" style="color:#800000;min-width:140px;"
onclick="$(this).button("disable");dataEntrySubmit(this);return false;"><span data-rc-lang="survey_200">Submit</span></button>
</td>
</tr>
<tr>
<td colspan="2" style="text-align:center;padding: 1px 0 10px;">
<button name="submit-btn-savereturnlater" tabindex="0" class="jqbutton ui-button ui-corner-all ui-widget" onclick="$(this).button("disable");dataEntrySubmit(this);return false;"><span data-rc-lang="data_entry_215">Save
& Return Later</span></button>
</td>
</tr>
</tbody>
</table>
</td>
</tr>
</tbody>
</table>
</div><input type="hidden" name="external-modules-temporary-record-id" value="external-modules-temporary-record-id-1679000576-1717556214">
</form>Text Content
CTSI How To Guides
Working...
0% means
50% means
100% means
This value you provided is not a number. Please try again.
This value you provided is not an integer. Please try again.
The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to
9-digit number, excluding leading zeros). Please try again.
The value you provided must be within the suggested range
The value you provided is outside the suggested range
This value is admissible, but you may wish to double check it.
The value entered must be a time value in the following format HH:MM within the
range 00:00-23:59 (e.g., 04:32 or 23:19).
This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it
now.
This field must be a 10 digit U.S. phone number (like 415 555 1212). Please
re-enter it now.
This field must be a valid email address (like joe@user.com). Please re-enter it
now.
The value you provided could not be validated because it does not follow the
expected format. Please try again.
Required format:
/^((0?[1-9])|([1-8][0-9])|(9[0-8]))[0-9]{3}$/
/^((29([-\/])02\3(\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00)))|((((0[1-9]|1\d|2[0-8])([-\/])(0[1-9]|1[012]))|((29|30)([-\/])(0[13-9]|1[012]))|(31([-\/])(0[13578]|1[02])))(\11|\15|\18)\d{4}))$/
/^((02([-\/])29\3(\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00)))|((((0[1-9]|1[012])([-\/])(0[1-9]|1\d|2[0-8]))|((0[13-9]|1[012])([-\/])(29|30))|((0[13578]|1[02])([-\/])31))(\11|\15|\19)\d{4}))$/
/^(((\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00))([-\/])02(\6)29)|(\d{4}([-\/])((0[1-9]|1[012])(\9)(0[1-9]|1\d|2[0-8])|((0[13-9]|1[012])(\9)(29|30))|((0[13578]|1[02])(\9)31))))$/
/^((29([-\/])02\3(\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00)))|((((0[1-9]|1\d|2[0-8])([-\/])(0[1-9]|1[012]))|((29|30)([-\/])(0[13-9]|1[012]))|(31([-\/])(0[13578]|1[02])))(\11|\15|\18)\d{4}))
(\d|[0-1]\d|[2][0-3]):[0-5]\d$/
/^((02([-\/])29\3(\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00)))|((((0[1-9]|1[012])([-\/])(0[1-9]|1\d|2[0-8]))|((0[13-9]|1[012])([-\/])(29|30))|((0[13578]|1[02])([-\/])31))(\11|\15|\19)\d{4}))
(\d|[0-1]\d|[2][0-3]):[0-5]\d$/
/^(((\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00))([-\/])02(\6)29)|(\d{4}([-\/])((0[1-9]|1[012])(\9)(0[1-9]|1\d|2[0-8])|((0[13-9]|1[012])(\9)(29|30))|((0[13578]|1[02])(\9)31))))
(\d|[0-1]\d|[2][0-3]):[0-5]\d$/
/^((29([-\/])02\3(\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00)))|((((0[1-9]|1\d|2[0-8])([-\/])(0[1-9]|1[012]))|((29|30)([-\/])(0[13-9]|1[012]))|(31([-\/])(0[13578]|1[02])))(\11|\15|\18)\d{4}))
(\d|[0-1]\d|[2][0-3])(:[0-5]\d){2}$/
/^((02([-\/])29\3(\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00)))|((((0[1-9]|1[012])([-\/])(0[1-9]|1\d|2[0-8]))|((0[13-9]|1[012])([-\/])(29|30))|((0[13578]|1[02])([-\/])31))(\11|\15|\19)\d{4}))
(\d|[0-1]\d|[2][0-3])(:[0-5]\d){2}$/
/^(((\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00))([-\/])02(\6)29)|(\d{4}([-\/])((0[1-9]|1[012])(\9)(0[1-9]|1\d|2[0-8])|((0[13-9]|1[012])(\9)(29|30))|((0[13578]|1[02])(\9)31))))
(\d|[0-1]\d|[2][0-3])(:[0-5]\d){2}$/
/^(?!\.)((?!.*\.{2})[a-zA-Z0-9\u0080-\u02AF\u0300-\u07FF\u0900-\u18AF\u1900-\u1A1F\u1B00-\u1B7F\u1D00-\u1FFF\u20D0-\u214F\u2C00-\u2DDF\u2F00-\u2FDF\u2FF0-\u2FFF\u3040-\u319F\u31C0-\uA4CF\uA700-\uA71F\uA800-\uA82F\uA840-\uA87F\uAC00-\uD7AF\uF900-\uFAFF!#$%&'*+\-/=?^_`{|}~\d]+)(\.[a-zA-Z0-9\u0080-\u02AF\u0300-\u07FF\u0900-\u18AF\u1900-\u1A1F\u1B00-\u1B7F\u1D00-\u1FFF\u20D0-\u214F\u2C00-\u2DDF\u2F00-\u2FDF\u2FF0-\u2FFF\u3040-\u319F\u31C0-\uA4CF\uA700-\uA71F\uA800-\uA82F\uA840-\uA87F\uAC00-\uD7AF\uF900-\uFAFF!#$%&'*+\-/=?^_`{|}~\d]+)*@(?!\.)([a-zA-Z0-9\u0080-\u02AF\u0300-\u07FF\u0900-\u18AF\u1900-\u1A1F\u1B00-\u1B7F\u1D00-\u1FFF\u20D0-\u214F\u2C00-\u2DDF\u2F00-\u2FDF\u2FF0-\u2FFF\u3040-\u319F\u31C0-\uA4CF\uA700-\uA71F\uA800-\uA82F\uA840-\uA87F\uAC00-\uD7AF\uF900-\uFAFF\-\.\d]+)((\.([a-zA-Z\u0080-\u02AF\u0300-\u07FF\u0900-\u18AF\u1900-\u1A1F\u1B00-\u1B7F\u1D00-\u1FFF\u20D0-\u214F\u2C00-\u2DDF\u2F00-\u2FDF\u2FF0-\u2FFF\u3040-\u319F\u31C0-\uA4CF\uA700-\uA71F\uA800-\uA82F\uA840-\uA87F\uAC00-\uD7AF\uF900-\uFAFF]){2,63})+)$/i
/^[-+]?\b\d+\b$/
/^[a-z]+$/i
/^\d{10}$/
/^[a-z0-9-_]+$/i
/^[-+]?[0-9]*\.?[0-9]+([eE][-+]?[0-9]+)?$/
/^-?\d+,\d$/
/^-?\d+\.\d$/
/^-?\d+,\d{2}$/
/^-?\d+\.\d{2}$/
/^-?\d+,\d{3}$/
/^-?\d+\.\d{3}$/
/^-?\d+,\d{4}$/
/^-?\d+\.\d{4}$/
/^[-+]?[0-9]*,?[0-9]+([eE][-+]?[0-9]+)?$/
/^(\(0[2-8]\)|0[2-8])\s*\d{4}\s*\d{4}$/
/^(?:\(?([2-9]0[1-9]|[2-9]1[02-9]|[2-9][2-9][0-9]|800|811)\)?)\s*(?:[.-]\s*)?([0-9]{3})\s*(?:[.-]\s*)?([0-9]{4})(?:\s*(?:#|x\.?|ext\.?|extension)\s*(\d+))?$/
/^((((\+44|0044)\s?\d{4}|\(?0\d{4}\)?)\s?\d{3}\s?\d{3})|(((\+44|0044)\s?\d{3}|\(?0\d{3}\)?)\s?\d{3}\s?\d{4})|(((\+44|0044)\s?\d{2}|\(?0\d{2}\)?)\s?\d{4}\s?\d{4}))(\s?\#(\d{4}|\d{3}))?$/
/^\d{4}$/
/^[ABCEGHJKLMNPRSTVXY]{1}\d{1}[A-Z]{1}\s*\d{1}[A-Z]{1}\d{1}$/i
/^(0[1-9]|[1-9]\d)\d{3}$/
/^\d{3}-\d\d-\d{4}$/
/^(\d|[01]\d|(2[0-3]))(:[0-5]\d){2}$/
/^([0-9]|[0-1][0-9]|[2][0-3]):([0-5][0-9])$/
/^[0-5]\d:[0-5]\d$/
/^[0-9]{4,9}$/
/^\d{5}(-\d{4})?$/
3c5LqffLIYc6dNVAgEEWGvLUk
CYSTOSCOPE PAN SURVEY
A A A
In order to improve our instrumentation process we are asking for your input.
Please complete the survey below to indicate instruments you prefer in each
tray.
* Listed in the survey are the current instruments in each pan along with the
quantity.
* The options allow you to select the quantity 0 (if none) up to 6 or more.
* If the desired quantity is more than 6, look at the bottom of the question and
enter the amount and item here.
* If an instrument is not listed please use the free text field to describe the
addition.
*Images are to assist in identification
Thank you!
Cannot select choice! The maximum number of choices has been selected.Value
removed!
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Cystoscope pan -does not include the power source
Bridge, Telescope, Single, w/ 1 Lockable Channel n=1
0 1 2 3 4 5 6+
reset
Bridge, Telescope, Double, w/ 2 Lockable Channels n=1
0 1 2 3 4 5 6+
reset
Clamp, Crile, Straight, 5 1/2" n=1,
0 1 2 3 4 5 6+
reset
Forceps, Biopsy, Double Action, Flexible, 9fr, 15 3/4"
0 1 2 3 4 5 6+
reset
Forceps, Grasping, Optical, Double Action, 12" n=1
0 1 2 3 4 5 6+
reset
Grasper, Alligator, Double Action, Flexible, 7fr, 15 3/4"
0 1 2 3 4 5 6+
reset
Obturator, Cystoscope-Urethroscope, 20fr n=1
0 1 2 3 4 5 6+
reset
Obturator, Cystoscope-Urethroscope, 22fr 12" n=1
0 1 2 3 4 5 6+
reset
Scissors, Mayo, Dissecting, Straight, 6 3/4" n=1
0 1 2 3 4 5 6+
reset
Towel Clip, Backhaus, Large, 5 1/4" n=1
0 1 2 3 4 5 6+
reset
Bridge, Telescope, Single, w/ 1 Lockable Channel n=1
Bridge, Telescope, Double, w/ 2 Lockable Channels n=1
Clamp, Crile, Straight, 5 1/2" n=1,
Forceps, Biopsy, Double Action, Flexible, 9fr, 15 3/4"
Forceps, Grasping, Optical, Double Action, 12" n=1
Grasper, Alligator, Double Action, Flexible, 7fr, 15 3/4"
Obturator, Cystoscope-Urethroscope, 20fr n=1
Obturator, Cystoscope-Urethroscope, 22fr 12" n=1
Scissors, Mayo, Dissecting, Straight, 6 3/4" n=1
Towel Clip, Backhaus, Large, 5 1/4" n=1
Exact quantity needed of: Bridge, Telescope, Single, w/ 1 Lockable Channel n=1
Exact quantity needed of: Bridge, Telescope, Double, w/ 2 Lockable Channels n=1
Exact quantity needed of: Clamp, Crile, Straight, 5 1/2" n=1,
Exact quantity needed of: Forceps, Biopsy, Double Action, Flexible, 9fr, 15 3/4"
Exact quantity needed of: Forceps, Grasping, Optical, Double Action, 12" n=1
Exact quantity needed of: Grasper, Alligator, Double Action, Flexible, 7fr, 15
3/4"
Exact quantity needed of: Obturator, Cystoscope-Urethroscope, 20fr n=1
Exact quantity needed of: Obturator, Cystoscope-Urethroscope, 22fr 12" n=1
Exact quantity needed of: Scissors, Mayo, Dissecting, Straight, 6 3/4" n=1
Exact quantity needed of: Towel Clip, Backhaus, Large, 5 1/4" n=1
List suggested additional items with qnty of each to add . If the specific name
is unknown, enter as much detail including size or image
Expand
Submit Save & Return Later
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survey, click the 'Return and Edit Response' button.
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