We're here to help! Please fill out the form below and an OrthoGrid Representative will contact you within one business day to help get your facility back up and running.
SECTION FILLED OUT BY INDIVIDUAL SUBMITTING SERVICE TICKET
Individual filling out the service ticket (Hospital Staff or OrthoGrid Internal).
If PhantomMSK (digital), enter Device Name as: "2019XXXXX" located on the Asset Tag.
If HipGrid Drone (analog) enter Device Name as "HipGrid Drone 9 or 12 inch and 40 or 45 degree".
What occurred, what broke, any actions taken to correct.
Part Numbers Listed below.
Calibration Array 9 inch - 1020-915-123
Calibration Array 12 inch - 1020-915-124
BNC / DVC Cable RA - 1020-916-119
Mouse - 1020-915-185
Keyboard - 1020-915-192
Teguar CPU - 1020-916-105
FSN Monitor - 1020-916-101
Power Strip- 1020-916-107
HipGrid Drone 9 inch 40 or 45 degree - 1015-009-125
HipGrid Drone 12 inch 40 or 45 degree - 1015-012-126
Please list the Serial Number or Lot Number if available.
Please enter in the date by which replacement part is needed.
Input complete Facility Name.
Individual who will be receiving support.
MANDATORY FIELD: Individuals address who will be receiving support and where the part, if needed, will be sent.
Enter phone number to contact individual if more details are needed.
Describe harm or no harm.
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