IPG {Serial/Lot Number}  
Model Number   Serial/Lot Number     Implant Date
{Filled in by server}   {Filled in by server}       {Filled in by server}
Manufacturer        
{Filled in by server}        

Single Chamber Parameter Settings
Pacing Mode
Lower Rate ppm
Upper Rate ppm
Amplitude . V
 
Pulse Width . ms
Sensitivity . mV
Polarity
Unipolar Bipolar