Attachment to Order
Tracoe Silcosoft Tracheostomy Tubes with and
without H2O Cuff for Children
Product variants*
To order, please specify: REF + Size + TL (e.g. REF 360-2.5-C26)
Customer
Name and
contact details
Patient ID / No.
(anonymised)
REF + Size + TL Number of units
Has been ordered before / Repeat order
Yes Order No.: No
This is a digital fillable PDF.
Date Signature and company stamp
*Please note that the production of a variant will
increase the delivery time and the product cannot
be exchanged.
Personal Information
Requests & additional information
Please send the completed attachment to order form by email to customersupport@atosmedical.com.