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Product order form for healthcare

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Product order form for healthcare

Drainage materials for healthcare facilities

Fill in as much as you can. If you have questions, please contact us. We are happy to help.

Order form for medical care

Please fill in the required fields and submit this form to complete your order.

Product Selection

Please select your desired products and quantities:

ewimed drainage set 2000 ml

ewimed drainage set 2000 ml (Art.No. 50-7505)

Minimum order quantity

1 pack = 10 pieces, sterile

Quantity:

PleurX™ drainage set, 500 ml

PleurX™ drainage set, 500 ml (Art.No. 50-7500B)

Minimum order quantity

1 pack = 10 pieces, sterile

Quantity:

PleurX™ drainage set, 1000 ml

PleurX™ drainage set, 1000 ml (Art.No. 50-7510)

Minimum order quantity

1 pack = 10 pieces, sterile

Quantity:

drainova® drainage set 2000 ml

drainova® drainage set 2000 ml (Art.No. 2010)

Minimum order quantity

1 pack = 10 pieces, sterile

Quantity:

drainova® dressing set

drainova® dressing set (Art.No. 8020)

Minimum order quantity

1 pack = 10 pieces, sterile

Quantity:

drainova® ArgentiC catheter

drainova® catheter (Art.No. 1140 ‘compact’)

Minimum order quantity

1 pack = 3 pieces

Quantity:

drainova® ArgentiC catheter

drainova® catheter (Art.No. 1150 ‘classic’)

Minimum order quantity

1 pack = 3 pieces

Quantity:

drainova® ArgentiC catheter

drainova® catheter (Art.No. 1160 ‘plus’)

Minimum order quantity

1 pack = 3 pieces

Quantity:

drainova® ArgentiC catheter

drainova® ArgentiC catheter (Art.No. 1240 ‘compact’)

Minimum order quantity

1 pack = 3 pieces

Quantity:

drainova® ArgentiC catheter

drainova® ArgentiC catheter (Art.No. 1250 ‘classic’)

Minimum order quantity

1 pack = 3 pieces

Quantity:

drainova® ArgentiC catheter

drainova® ArgentiC catheter (Art.No. 1260 ‘plus’)

Minimum order quantity

1 pack = 3 pieces

Quantity:

PleurX™ pleural catheter

PleurX™ pleural catheter (Art.No. 50-7050)

Minimum order quantity

1 pack = 3 pieces, sterile

Quantity:

PeritX™ ascites catheter

PeritX™ ascites catheter (Art.No. 50-9050A)

Minimum order quantity

1 pack = 3 pieces, sterile

Quantity:

ewimed drainage bag – Volume 2000 ml

ewimed drainage bag – Volume 2000 ml (Art.No. 50-7220)

Minimum order quantity

1 pack = 10 pieces, sterile

Quantity:

PleurX™ vacuum bottle 1000 ml

PleurX™ vacuum bottle 1000 ml (Art.No. 50-7210)

Minimum order quantity

1 pack = 10 pieces, sterile

Quantity:

drainova® reservoir, soft vacuum 2000 ml

drainova® reservoir, soft vacuum (Art.No. 2000)

Minimum order quantity

1 pack = 10 pieces

Quantity:

ewimed Pneu-Pack I

ewimed Pneu-Pack I (Art.No. P8531)

Minimum order quantity

1 pack = 10 pieces

Quantity:

Valve cap

Valve cap (Art.No. 50-7235A)

Minimum order quantity

1 pack = 10 pieces, sterile

Quantity:

drainova® silicone cap, sterile

drainova® silicone cap, sterile (Art.No. 9060)

Minimum order quantity

1 pack = 10 pieces, sterile

Quantity:

drainova® rinsing tube

drainova® rinsing tube (Art.No. 6060/2)

Minimum order quantity

1 pack = 2 pieces, sterile

Quantity:

Safe-T-Centesis™, 6 Fr

Safe-T-Centesis™, 6 Fr (Art.No. PIG 1260K)

Minimum order quantity

1 pack = 10 pieces, sterile

Quantity:

Safe-T-Centesis™, 8 Fr

Safe-T-Centesis™, 8 Fr (Art.No. PIG 1280K)

Minimum order quantity

1 pack = 10 pieces, sterile

Quantity:

Thoracocentesis-Paracentesis catheter set (TPK), 8 Fr

Thoracocentesis-Paracentesis catheter set (TPK), 8 Fr (Art.No. TPK1001)

Minimum order quantity

1 pack = 10 pieces, sterile

Quantity:

Thoracocentesis-Paracentesis catheter set (TPK), 5 Fr

Thoracocentesis-Paracentesis catheter set (TPK), 5 Fr (Art.No. TPK1005)

Minimum order quantity

1 pack = 10 piece, sterile

Quantity:

drainova® adapter 3/8″ to Luer Lock

drainova® adapter 3/8″ to Luer Lock (Art.No. P8448)

Minimum order quantity

1 pack = 10 pieces, sterile

Quantity:

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Order Information

Please fill in the following information:

Paying entity: * Reference number/Cost center (if applicable): Contact person for the order: * Purchaser's phone number: *

Purchaser's email address: * (confirmation will be sent to this email address) Hospital name: Department/Reception/Health Center/HSV:

Type of implantation: *

PleuralAscites

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Delivery Address

Unit: Street address: Zip code:

City: Phone number for UPS delivery contact: Additional information, special instructions, gate code etc.:

Fields marked with an * must be filled in.

I have read the web policy and accept it* Please leave this field empty.

Products for drainage of pleural effusion and ascites.

ewimed Sweden AB

Ekbacksvägen 28
168 69 Bromma

+46 8-25 11 69

info.se@ewimed.com

ewimed Austria GmbH

ewimed Switzerland AG

ewimed Denmark A/S

ewiCare Medical Center

ewimed Norway AS

ewimed Netherlands B.V.

ewimed Belgium BV

ewimed Luxemburg

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