Section J Attchmnt - List of Equip per Service Unit.pdf

Facility Name Location Control ID Standard Name Device Name Manufacturer Model # Serial #

Cheyenne River Hlth Cntr Eagle Butte, SD 45EBB-A00367 Stand, Ophthalmic

Examination/Treatment

Stands, Ophthalmic Marco Ophthalmic Inc 1290 Encore 06J0141

Cheyenne River Hlth Cntr Eagle Butte, SD 45EBB-A00368 Chair, Exam, Ophthalmic

Chairs, Exam, Trtmnt, Ophthalmology Marco Ophthalmic Inc 1262 11F0104

Cheyenne River Hlth Cntr Eagle Butte, SD 45EBB-A00369

Refractor, Ophthalmic

(Phoroptor)

Refractors, Ophthalmic, Manual

Reichert Ophthalmic Instrmnts

Div Reichert Inc 11636 84599-0611

Cheyenne River Hlth Cntr Eagle Butte, SD 45EBB-A00370 Slit Lamp Slit Lamps

Haag-Streit Group USA Div

Haag-Streit Holding AG BQ 900 900.7.2.28649

Cheyenne River Hlth Cntr Eagle Butte, SD 45EBB-A00371 Chart, Visual Acuity Charts, Eye, Visual Acuity Lombart Instrument CVSi21 SQP1122WDDAS

Cheyenne River Hlth Cntr Eagle Butte, SD 45EBB-A00372 Chair, Exam, Ophthalmic

Chairs, Exam, Trtmnt, Ophthalmology Marco Ophthalmic Inc 1262 11F0105

Cheyenne River Hlth Cntr Eagle Butte, SD 45EBB-A00373 Stand, Ophthalmic

Examination/Treatment

Stands, Ophthalmic Marco Ophthalmic Inc 1290 Encore 07F0106

Cheyenne River Hlth Cntr Eagle Butte, SD 45EBB-A00374

Refractor, Ophthalmic

(Phoroptor)

Refractors, Ophthalmic, Manual

Reichert Ophthalmic Instrmnts

Div Reichert Inc 11636 30367-08

Cheyenne River Hlth Cntr Eagle Butte, SD 45EBB-A00375 Slit Lamp Slit Lamps

Haag-Streit Group USA Div

Haag-Streit Holding AG BQ 900 900.7.2.28647

Cheyenne River Hlth Cntr Eagle Butte, SD 45EBB-A00377 Chart, Visual Acuity Charts, Eye, Visual Acuity Lombart Instrument CVSi21 SQP1121F8DAS

Cheyenne River Hlth Cntr Eagle Butte, SD 45EBB-A00378 Chair, Exam, Ophthalmic

Chairs, Exam, Trtmnt, Ophthalmology Marco Ophthalmic Inc 1262 11F0103

Cheyenne River Hlth Cntr Eagle Butte, SD 45EBB-A00379 Stand, Ophthalmic

Examination/Treatment

Stands, Ophthalmic Marco Ophthalmic Inc 1290 Encore 09G0095

Cheyenne River Hlth Cntr Eagle Butte, SD 45EBB-A00380

Refractor, Ophthalmic

(Phoroptor)

Refractors, Ophthalmic, Manual

Reichert Ophthalmic Instrmnts

Div Reichert Inc 11636 84601-0611

Cheyenne River Hlth Cntr Eagle Butte, SD 45EBB-A00381 Slit Lamp Slit Lamps

Haag-Streit Group USA Div

Haag-Streit Holding AG BQ 900 900.7.2.28648

Cheyenne River Hlth Cntr Eagle Butte, SD 45EBB-A00382 Chart, Visual Acuity Charts, Eye, Visual Acuity Lombart Instrument CVSi21 SQP1122T4DAS

Cheyenne River Hlth Cntr Eagle Butte, SD 45EBB-A00384

Refractor, Ophthalmic

(Phoroptor)

Refractors, Ophthalmic, Manual

Reichert Ophthalmic Instrmnts

Div Reichert Inc 11636 84600-061

Cheyenne River Hlth Cntr Eagle Butte, SD 45EBB-A00472 Ophthalmascope Ophthalmoscopes, Indirect Heine USA Ltd Omega 500 1120006534

Cheyenne River Hlth Cntr Eagle Butte, SD 45EBB-A00473 Ophthalmascope Ophthalmoscopes, Indirect Heine USA Ltd Omega 500 1120006569

Cheyenne River Hlth Cntr Eagle Butte, SD 45EBB-A00474 Ophthalmascope Ophthalmoscopes, Indirect Heine USA Ltd Omega 500 1120005890

Spirit Lake Health

Center Ft Totten, ND 45FNB-000350 Phoropter

Refractors, Ophthalmic, Manual

Reichert Ophthalmic

Instruments Div Reichert

Inc 11625 BF54635

Spirit Lake Health

Center Ft Totten, ND 45FNB-001203

Chair, Exam, Ophthalmic

Chairs, Exam, Treatment, Ophthalmology

Reliance Medical

Products Inc Div Haag-

Streit Holding AG 6200L

17B060902

Spirit Lake Health

Center Ft Totten, ND 45FNB-002051

Vision Acuity

Tester

Analyzers, Physiologic, Visual Function

Reichert Ophthalmic

Instruments Div Reichert

Inc 13760 52280-0314

Spirit Lake Health

Center Ft Totten, ND 45FNB-X60687 Lensometer Lensometers

Reichert Ophthalmic

Instruments Div Reichert

Inc 12603 AZ 14504

Spirit Lake Health

Center Ft Totten, ND 45FNB-X60688 Slip Lamp Slit Lamps

Topcon Medical Systems

Inc SL-2ED 623171

Spirit Lake Health

Center Ft Totten, ND 45FNB-X60689

Stand, Ophthalmology

Exam, Treatment

Stands, Ophthalmic

Reliance Medical

Products Inc Div Haag-

Streit Holding AG 7700 25581

Facility Name Location Control ID Standard Name Device Name Manufacturer Model # Serial # Ft Thompson Health

Center

Ft Thompson, SD 45FTB-002069 Tonometer

Tonometers, Ophthalmic Reichert Technologies Reichert 7 02822-0611

Ft Thompson Health

Center

Ft Thompson, SD 45FTB-002308 Pupillometer Pupillometers Essilor of America Inc X81705 051487

Ft Thompson Health

Center

Ft Thompson, SD 45FTB-002310 Ophthalmascope

Ophthalmoscopes

, Indirect Keeler Instruments Inc

Vantage

Plus 11917

Ft Thompson Health

Center

Ft Thompson, SD 45FTB-X62226

Ophthalmoscope, Binocular, Indirect

Ophthalmoscopes

, Indirect Keeler Instruments Inc All Pupil M022916

Facility Name Location Control ID Std Name Device Name Manufacturer Model # Serial #

Ft Yates Hospital (Standing

Rock Service Unit) Ft Yates, ND 45FYB-002319 Tonometer Tonometers, Ophthalmic

Reichert Ophthalmic Instruments Div

Reichert Inc AVIA 43223-1214

Ft Yates Hospital (Standing

Rock Service Unit) Ft Yates, ND 45FYB-002320 Tonometer Tonometers, Ophthalmic

Reichert Ophthalmic Instruments Div

Reichert Inc AVIA 38361-0312

Ft Yates Hospital (Standing

Rock Service Unit) Ft Yates, ND 45FYB-002322 Headlight Headlights Keeler Instruments Inc 1202-P-6237 Unknown

Ft Yates Hospital (Standing

Rock Service Unit) Ft Yates, ND 45FYB-X60900 Lensometer Lensometers

Reichert Ophthalmic Instruments Div

Reichert Inc 12603 AY13172

Ft Yates Hospital (Standing

Rock Service Unit) Ft Yates, ND 45FYB-X60928 Keratometer Ophthalmometers

Reichert Ophthalmic Instruments Div

Reichert Inc 71-21-35 12132ET

Ft Yates Hospital (Standing

Rock Service Unit) Ft Yates, ND 45FYB-X60929 Slit Lamp Slit Lamps

Haag-Streit Group USA Div Haag-Streit

Holding AG BM 900 B 90032469

Ft Yates Hospital (Standing

Rock Service Unit) Ft Yates, ND 45FYB-X60933

Chair, Exam, Ophthalmic

Chairs, Exam, Trtmnt, Ophthalmology

Reliance Medical Products Inc Div

Haag-Streit Holding AG 980HFC 0141574

Ft Yates Hospital (Standing

Rock Service Unit) Ft Yates, ND 45FYB-X60934

Stand, Ophthalmology

Exam Trtmnt Stands, Ophthalmic

Reliance Medical Products Inc Div

Haag-Streit Holding AG 7700 0096938

Ft Yates Hospital (Standing

Rock Service Unit) Ft Yates, ND 45FYB-X60936 Keratometer Ophthalmometers Marco Ophthalmic Inc Model 1 21650

Ft Yates Hospital (Standing

Rock Service Unit) Ft Yates, ND 45FYB-X60941 Lensometer Lensometers

Reichert Ophthalmic Instruments Div

Reichert Inc 12603 AY 13215

Ft Yates Hospital (Standing

Rock Service Unit) Ft Yates, ND 45FYB-X60967

Chair, Exam, Ophthalmic

Chairs, Exam, Trtmnt, Ophthalmology

Reliance Medical Products Inc Div

Haag-Streit Holding AG 980HFC 0141570

Ft Yates Hospital (Standing

Rock Service Unit) Ft Yates, ND 45FYB-X63525

Stand, Ophthalmology

Exam, Trtmnt Stands, Ophthalmic

Reliance Medical Products Inc Div

Haag-Streit Holding AG 7700 0141673

Ft Yates Hospital (Standing

Rock Service Unit) Ft Yates, ND 45FYB-X64789 Headlight Headlights Keeler Instruments Inc 1202-P-6106 012745

Kyle Health Center (Pine

Ridge Service Unit) Kyle, SD 45PRB-KY002078 Chair, Exam, Ophthalmic

Chairs, Exam, Trmnt, Ophthalmology

Reliance Medical Products Inc Div

Haag-Streit Holding AG 7720 772011K1007002

Kyle Health Center (Pine

Ridge Service Unit) Kyle, SD 45PRB-KY002079

Chairs, Exam/Treatment, Ophthalmic

Chairs, Exam, Trmnt, Ophthalmology

Reliance Medical Products Inc Div

Haag-Streit Holding AG 980L 098047B1107001

Kyle Health Center (Pine

Ridge Service Unit) Kyle, SD 45PRB-KY003253 Ophthalmascope Ophthalmoscopes, Indirect Keeler Instruments Inc Vantage Plus 87339

Kyle Health Center (Pine

Ridge Service Unit) Kyle, SD 45PRB-KY003257 Chart, Visual Acuity Charts, Eye, Visual Acuity

Reichert Ophthalmic Instruments

Div Reichert Inc

ClearChart 2 /

13795 40009-0719

Kyle Health Center (Pine

Ridge Service Unit) Kyle, SD 45PRB-KYX40792 Photometer Photometers

Reichert Ophthalmic Instruments

Div Reichert Inc 11625 14240-9

Kyle Health Center (Pine

Ridge Service Unit) Kyle, SD 45PRB-KYX40795 Slit Lamp Slit Lamps

Haag-Streit Group USA Div Haag-

Streit Holding AG BQ 900 900.2.1.58541

Kyle Health Center (Pine

Ridge Service Unit) Kyle, SD 45PRB-KYX40796 Keratometer Ophthalmometers

Reichert Ophthalmic Instruments

Div Reichert Inc 71-21-35 10446-9Kyle Health Center (Pine

Ridge Service Unit) Kyle, SD 45PRB-KYX41032 Lensometer Lensometers

Reichert Ophthalmic Instruments

Div Reichert Inc 12603 10796-9

Facility Name Location Control ID Standard Name Device Name Manufacturer Model # Serial # Wanblee Health Center

(Pine Ridge Service Unit) Wanblee, SD 45PRB-WB002031 Lensometers Lensometers Marco Ophthalmic Inc 201 2517

Wanblee Health Center

(Pine Ridge Service Unit) Wanblee, SD 45PRB-WB002033 Chair, Exam, Ophthalmic

Chairs, Exam, Trmnt, Ophthalmology Marco Ophthalmic Inc Pro 120G 01-G0199

Wanblee Health Center

(Pine Ridge Service Unit) Wanblee, SD 45PRB-WB002034 Lights, Exam Lights, Examination Heine USA Ltd

Omega 180 / EN

30 0 / 08081

Wanblee Health Center

(Pine Ridge Service Unit) Wanblee, SD 45PRB-WB002035 Projector, Charts Eye Projectors, Chart, Eye CP-670 325854

Wanblee Health Center

(Pine Ridge Service Unit) Wanblee, SD 45PRB-WB002036 Phoropters

Refractors, Ophthalmic, Manual Marco Ophthalmic Inc RT 300 33072

Wanblee Health Center

(Pine Ridge Service Unit) Wanblee, SD 45PRB-WB002037 Tonometer Tonometers, Ophthalmic Marco Ophthalmic Inc 11222 2320324

Wanblee Health Center

(Pine Ridge Service Unit) Wanblee, SD 45PRB-WB004002 Pupillometer Pupillometers Essilor of America Inc X81705 049099

Wanblee Health Center

(Pine Ridge Service Unit) Wanblee, SD 45PRB-WBX41697 Chair, Exam, Ophthalmic

Chairs, Exam, Trmnt, Ophthalmology Marco Ophthalmic Inc 1262 00H0306

Rosebud Hospital Rosebud, SD 45RBB-003680 Phoropter

Refractors, Ophthalmic, Manual

Reichert Ophthalmic Instr

Div Reichert Inc 11625 16696-1

Rosebud Hospital Rosebud, SD 45RBB-003681 Ophthalmascope Ophthalmoscopes, Indrct Keeler Instruments Inc Vantage Plus 64907

Rosebud Hospital Rosebud, SD 45RBB-003696 Chair, Exam, Ophthalmic

Chairs, Exam, Trtmnt, Ophthalmology

Reliance Medical

Products Inc Div Haag-

Streit Holding AG 980 098048D1117030

Rosebud Hospital Rosebud, SD 45RBB-003697 Stands

Exam, Trtmnt, Stands, Ophthalmic

Reliance Medical

Products Inc Div Haag-

Streit Holding AG 7900 790000J1017048

Rosebud Hospital Rosebud, SD 45RBB-003819 Slit Lamp Slit Lamps

Reliance Medical

Products Inc Div Haag-

Streit Holding AG BQ 900 02476

Rosebud Hospital Rosebud, SD 45RBB-003820 Tonometer, Applination Tonometers, Ophthalmic

Reliance Medical

Products Inc Div Haag-

Streit Holding AG AT900BQ 13012

Rosebud Hospital Rosebud, SD 45RBB-003963 Chart, Visual Acuity Charts, Eye, Visual Acuity Nidek Inc SC-1600 409799

Rosebud Hospital Rosebud, SD 45RBB-X01431 Keratometer Ophthalmometers

Reichert Ophthalmic Instr

Div Reichert Inc 71-21-35 10267-9

Rosebud Hospital Rosebud, SD 45RBB-X01432 Slit Lamp Slit Lamps

Reliance Medical

Products Inc Div Haag-

Streit Holding AG 22982A 900 1356466

Rosebud Hospital Rosebud, SD 45RBB-X01454 Lensometer Lensometers

Reichert Ophthalmic Instr

Div Reichert Inc 12603 11030-9

Rosebud Hospital Rosebud, SD 45RBB-X01455 Lensometer Lensometers

Reichert Ophthalmic Instr

Div Reichert Inc 12603 11027-9

Rosebud Hospital Rosebud, SD 45RBB-X01457 Keratometer Ophthalmometers

Reichert Ophthalmic Instr

Div Reichert Inc 71-21-35 10223-9

Rosebud Hospital Rosebud, SD 45RBB-X01458 Stand, Ophthalmology

Exam, Trtmnt, Stands, Ophthalmic

Reliance Medical

Products Inc Div Haag-

Streit Holding AG 7700 58272

Rosebud Hospital Rosebud, SD 45RBB-X01460 Projector Projectors, Chart, Eye Marco Ophthalmic Inc CP-600 30802

Rosebud Hospital Rosebud, SD 45RBB-X01849 Projector Eye Chart Projectors, Chart, Eye Marco Ophthalmic Inc CP-670 325015

Rosebud Hospital Rosebud, SD 45RBB-X01907 Tonometer Tonometers, Ophthalmic

Reliance Medical

Products Inc Div Haag-

Streit Holding AG H03 9004496336

Rosebud Hospital Rosebud, SD 45RBB-X01928 Lensometer Lensometers Marco Ophthalmic Inc 101 32800

Rapid City Health Center

(IHS) Rapid City, SD 45RCB-000063 Phoropter

Refractors, Ophthalmic, Manual

Reichert Ophthalmic Instr

Div Reichert Inc 11625B 34760-00

Rapid City Health Center

(IHS) Rapid City, SD 45RCB-000496 Phoropter

Refractors, Ophthalmic, Manual

Reichert Ophthalmic Instr

Div Reichert Inc 11625B BF53987

Rapid City Health Center

(IHS) Rapid City, SD 45RCB-001625 Headlight Headlights

Heine Optotechnik GmbH &

Co KG Ohmega 180 16331

Rapid City Health Center

(IHS) Rapid City, SD 45RCB-001643 Stand

Examination/Treatment

Stands, Ophthalmic Marco Ophthalmic Inc 1206 12B0116

Rapid City Health Center

(IHS) Rapid City, SD 45RCB-001644

Chair, Exam, Ophthalmic

Chairs, Examination/Treatment, Ophthalmology Marco Ophthalmic Inc 1220 12B0038

Rapid City Health Center

(IHS) Rapid City, SD 45RCB-001645

Chair, Exam, Ophthalmic

Chairs, Examination/Treatment, Ophthalmology

Reliance Medical Products

Inc Div Haag-Streit Holding

AG 940 940002F0912001

Rapid City Health Center

(IHS) Rapid City, SD 45RCB-001930

Chair, Exam, Ophthalmic

Chairs, Examination/Treatment, Ophthalmology

Reliance Medical Products

Inc Div Haag-Streit Holding

AG 7000 070025C0516032

Rapid City Health Center

(IHS) Rapid City, SD 45RCB-001931 Stand, Ophthalmic

Examination/Treatment

Stands, Ophthalmic

Reliance Medical Products

Inc Div Haag-Streit Holding

AG 7800 Reliance 780003E0416012

Rapid City Health Center

(IHS) Rapid City, SD 45RCB-001932 Ophthalmascope Ophthalmoscopes, Indirect Heine USA Ltd Omega 500 1100390114

Rapid City Health Center

(IHS) Rapid City, SD 45RCB-001933 Chart, Visual Acuity Charts, Eye, Visual Acuity

Reichert Ophthalmic Instr

Div Reichert Inc

ClearChart 2 /

13760 55190-0416

Rapid City Health Center

(IHS) Rapid City, SD 45RCB-001934 Chart, Visual Acuity Charts, Eye, Visual Acuity

Reichert Ophthalmic Instr

Div Reichert Inc

ClearChart 2 /

13760 55192-0416

Rapid City Health Center

(IHS) Rapid City, SD 45RCB-X64213 Lensometer Lensometers

Reichert Ophthalmic Instr

Div Reichert Inc 12603 AX12953

Rapid City Health Center

(IHS) Rapid City, SD 45RCB-X64794 Phoropter Phorometers Reichert Technologies T1625 AY27597

Rapid City Health Center

(IHS) Rapid City, SD 45RCB-X64796 Slit Lamp Slit Lamps

Haag-Streit Group USA Div

Haag-Streit Holding AG BQ900 01576

Rapid City Health Center

(IHS) Rapid City, SD 45RCB-X70711 Keratometer Ophthalmometers Marco Ophthalmic Inc I 18379

Rapid City Health Center

(IHS) Rapid City, SD 45RCB-X70773 Eye Chart Projector Projectors, Chart, Eye Marco Ophthalmic Inc CP670 325377

Rapid City Health Center

(IHS) Rapid City, SD 45RCB-X70776 Eye Chart Projector Projectors, Chart, Eye Marco Ophthalmic Inc CP670 325436