Defibrillation Lead Serial Number   Model Number Date of Implant
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Location
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Defibrillation Lead Measurements
High Voltage Pathway DFT/LED Impedance
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Previous Device 1 Data
Lead Model No. Lead Serial No. Lead Manufacturer
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Previous Device Status Prior Implant Date
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Device Replaced Date    
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Previous Device 2 Data
Lead Model No. Lead Serial No. Lead Manufacturer
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Previous Device Status Prior Implant Date
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Device Replaced Date    
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