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General
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DME
• • •
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CPAP Machine
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Make, Model and size
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Mask
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Make, Model and size
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Humidifier
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Make, Model and size
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Headgear
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Make, Model and size
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Tubing
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Make, Model and size
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Chin Strap (if needed)
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Make, Model and size
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Nasal Cushion (if needed)
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Make, Model and size
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Pt understand how to clean and maint. of equip?
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Pt demonstrates proper set up / usage of equip?
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Pt understands purpose / significance of CPAP ?
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