Attachment H.docx

Attachment H is a preventive maintenance sticker template for VA oxygen concentrator equipment, designed for tracking and managing medical device maintenance within VISN 12 facilities. The document provides a structured form for recording equipment details including manufacturer, model, serial number, and inspection documentation with spaces for date, hours, and inspector initials.

The sticker is specifically related to the VA VISN 12 Home Oxygen Delivery Services contract (Solicitation Number 36C25225R0072), which covers oxygen delivery services for multiple VA medical centers across Wisconsin, Michigan, and Illinois, including facilities in Milwaukee, Madison, Tomah, Iron Mountain, North Chicago, Hines, Chicago, and Danville. The maintenance tracking document supports the clinical respiratory assessment process for vendor-supplied oxygen equipment, ensuring proper documentation and tracking of preventive maintenance inspections across the VA healthcare network.