Ordering Seeds...

                                                  

PROSTASEED I-125 SOURCES ORDER FORM

Date:
   		 Ordered By:
Customer:  Implant Date:  
Performing Physician: Delivery Date:
Purchase Order #: Patient Name:
Loose Seeds  

Loaded in Mick Cartridges 
  

Calibration Date:
Friday of the Implant Week 
            or                     
Friday Before Implant Week 

Strength Code

Order Quantity

Activity Level
(mCi App, NIST 99)

A 0.188
B 0.204
C 0.221
D 0.240
E 0.260
F 0.282
G 0.306
H 0.332
I 0.361
J 0.391
K 0.424
L 0.460
M 0.499
N 0.542
O 0.588
P 0.638
Q 0.692
R 0.750
S 0.814
T 0.883
U 0.958
V 1.039

Calibration Seed      Activity      Quantity

Submit completed form below or fax printed form to PSA
Phone:  (877) 438-4125      Fax:  (561) 842-6660
Email:  info@prostateservices.com


 

 

  For any additional information needed, contact us below:

Prostate Services of America, Inc.
2655 N. Ocean Drive Suite 405 ~ Singer Island, Fl.  33404
Toll free: 1-877-GET-I-125  0r  561-842-8900
Fax: 561-842-6660
E-mail:  Info@prostateservices.com

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